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A CENTURY 



AMERICAN MEDICINE 



1776-1876 



BY 

EDWARD H. CLARKE, M.D., 

LATE PROFESSOR OF MATERIA MEDICA IN HARVARD UNIVERSITY, ETC. 

HENRY J. BIGELOW, M.D., 

PROFESSOR OF SURGERY IN HARVARD UNIVERSITY, ETC. ; 

SAMUEL D. GROSS, M.D.,LL.D., D.C L. Oxon., 

PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE, PHILA., : 

T. GAILLARD THOMAS, M.D., 

PROFESSOR OF OBSTETRICS, ETC., IN THE COLLEGE OF PHYSICIANS 
AND SURGEONS, NEW YORK, ETC. ; 



J. S. BILLINGS, M.D, 

LIBRARIAN TO THE NATIONAL MEDICAL LIBRARY 
WASHINGTON, D. C. 




PHILADELPHIA: 
HENRY C. LEA. 

1876. 



U.sV. 

C. 2^ 



Entered according to the Act of Congress, in the year 1876, by 

HENRY C. LEA, 
in the Office of the Librarian of Congress. All rights reserved. 



PHII.ADELPniA: 
COLLINS, PRINTER, 

70.") .Tdyue .S;rtet. 



PUBLISHER'S NOTE 



The following papers, during their publication in the 
"American Journal of the Medical Sciences," have 
met with commendation so general, that it has seemed 
due to the profession whose development for the last 
hundred years is here traced with so much fidelit}^, 
to place them in a form more convenient for future 
preservation and reference. Taken as a whole, they 
present a complete and connected review of the pro- 
gress of medical science in America during the whole of 
the period in which medicine can be considered to be 
a science ; and the volume, it is therefore hoped, will 
possess not only interest in the present, but an enduring 
value in the future. 

Philadelphia, October, 1876. 



PRACTICAL MEDICINE 



BY 



EDWARD H. CLARKE, M.D., A. A.S., 

LATE PROFEiSSOR OF MATERIA MEDICA IX HARVARD UNIVERSIXr. 



PRACTICAL MEDICINE.' 



When Boerhaave, the most accomplished and celebrated 
physician of the 18th century, died, he left behind him an 
elegant volume, the title-page of which declared that it con- 
tained all the secrets of medicine. On opening the volume 
every page, except one, was blank. On that one was written, 
"keep the head cool, the feet warm, and the bowels open." 
This legacy of Boerhaave to suffering humanity typified, not 
inaptly or unjustly, the acquirements, not of medical science, 
but of medical art at the close of the 18th century. Empi- 
ricism, authority, and theory ruled the medical practice of 
the world at that time. The result of therapeutical experi- 
ence from Hippocrates to Boerhaave was fairly summed up 
by the latter in the eleven words we have just quoted. To 
quiet the nervous system, to equalize the circulation, to 
provide for the normal action of the intestinal canal, and to 
leave all the rest to the vis medicatrix naturcB was sound 
medical treatment, and it was as far as a sound therapeutics 
had gone a hundred years ago. This goal had been reached 
by empiricism. Wise practitioners like Boerhaave, Syden- 
ham, Morgagni, and a few others, were content to restrain 
their materia medica within these modest limits. The vast 
majority of practitioners, however, either blindly followed 

' The author desires to acknowledge his indebtedness to Dr. R. 
H. Fitz, Assistant Professor of Pathological Anatomy in Harvard 
University, for invaluable aid in collecting many of the data upon 
which this essay is founded. 



4 PRACTICAL MEDICINE. 

authority of the past, and bled and dosed by the book, or 
adopted some strange theory of planetary influence, signa- 
tures, animal spirits, or occult force, and treated disease in 
accordance with whatever theory they chanced to believe in. 
Medical practice, as a rule, deserved the ridicule of Moliere 
and the satire of Montaigne 

In making these statements we do not forget that there 
had been real progress in many departments of medical 
science. Anatomy, physiology, surgery, chemistry, and 
physics had made substantial conquests within their own 
domains. We do not forget that Harvey had discovered 
the circulation of the blood ; that Haller, one of the greatest 
names in medicine, had discerned the fact of muscular irri- 
tability, and its connection with the nerves; that Albinus 
had introduced thoroughness and exactness, so far as the 
means and instruments of observation accessible to him 
rendered them possible, into anatomical investigation ; that 
Morgagni had founded the science of pathological anatomy, 
which has since yielded such magnificent results; that 
Astruc in 1743 had announced the reflex phenomena of the 
nervous system, which Prochaska before the close of the 
century more fully developed ; that Boerhaave, Sydenham, 
Mead, Hoff'mann, and Stahl had rendered good service to 
practical medicine ; that Franklin and others had brought 
electricity, magnetism, and galvanism into the domains of 
science, though their relations to medicine and physiology 
were not then recognized ; and that chemistry had entered 
upon a career of investigation which it has since followed 
with extraordinary success. But all these discoveries were 
in the nature of isolated facts. They w^ere more like islands, 
surrounded by an unknown ocean, than like parts of a con- 
tinent, intimately connected with each other and forming 
portions of a grand and systematic whole. 

In spite of these achievements, however, theory, empiri- 
cism, and authority ruled the medical world at the close of 



PRACTICAL MEDICINE. 5 

the 18th and beginning of the 19th century. Let ns look 
at some illustrations of this statement. 

Cullen, who flourished during the middle of that century, 
reasoning from a jwnon considerations, founded his patho- 
logy and nosology upon pure theory. He not only did this, 
but he recognized the fact that he did so and defended 
himself in doing it. He declared it to be the duty of a 
philosophical inquirer in medicine to control his observations 
by his theories, and not his theories by his observations. 
In like manner he maintained that the medical practitioner 
should be guided at the bedside, less by the indications of 
nature than by theoretical considerations. Such was the 
attitude with regard to the theory and practice of medicine 
of one of the most philosophical thinkers and learned 
physicians of that period. He was by far the ablest of the 
solidists. His views met with general acceptance in Eng- 
land, and excited a great influence upon the medical opinions 
and practice of this country, and especially of Xew England. 
Much of the practice of our fathers and many of their 
medical opinions may be traced directly to Cullen. He was 
too often obeyed as a superior. Fortunate was it that the 
common sense and independence of American physicians 
often led them to refuse obedience to his authority and to 
follow the guidance of rational empiricism. 

Brown's theory of medicine, which appeared not long 
after that of Cullen, is another illustration of the si)eculative 
tendency of medicine at that time. Brown was a man of 
less breadth, learning, and power, but of a more practical 
turn, than Cullen. His practical tendencies led him to 
base his system chiefly on therapeutics. Its pathology was 
essentially that of Cullen, and its physiology a misconception 
of the Hallerian notion of irritability. Its essential error 
was that it rested not upon facts, but upon assumptions. 
Its motive was a desire to substitute a stimulating for a 
lowering method of treatment. Its practical characteristics, 

1* 



6 PRACTICAL MEDICINE. 

however, caused it to spread more rapidly and to exert a 
more profound influence over the medical opinions and 
practice of his time than that of his more philosophical 
contemporary. It rapidly made its way into Germany, 
France, and Italy. Dr. Rush, of Philadelphia, illustrious 
as a practitioner, writer, and signer of the Declaration of 
Independence, who was a disciple of Brown, imported it into 
America. Introduced under such auspices, it spread rapidly 
throughout the country and produced a deep and lasting 
impression upon American medicine. 

The speculative tendency to which we have referred, found 
its most extravagant expression and attained its largest de- 
velopment in the theory which Hahnemann framed near the 
beginning of the present century. Although, on account 
of its manifest absurdities, it was rejected by all scientific 
men, yet, to the philosophic student of the history of medi- 
cine for the past hundred years, it is interesting, not only as 
a curious instance of the aberration of the human intellect, 
but because, without contributing at all to the progress of 
medical science, it has modified the therapeutics of the pre- 
sent age by reminding the physician of the limits of his art, 
and of the great part which nature plays in the cure of 
disease. Hahnemann ignored all previous medical know- 
ledge. He denied that medicine was a branch of natural 
science; tiiat any knowledge of anatomy, or physiology, or 
pathological anatomy, or of diagnosis, or of the investiga- 
tion of the nature of disease was necessary to the physician ; 
and also denied the existence of any curative power in the 
human system. Consciously, or unconsciously, abstracting 
from the mediaeval doctrine of signatures its guiding princi- 
ple, that the like colour cures the like colour, he declared 
that like cures like, similia similihus curaniur. To this he 
added the doctrine of the potency of dilutions, and later 
admitted certain diseases which he called psora, sycosis, 
etc., as modifying elements. Symptoms and groups of 



PRACTICAL MEDICINE 7 

symptoms were all that were worthy of the attention of the 
physician, and these were to be treated by potencies in 
accordance with his fundamental theory. It is unneces- 
sary to allude to the modifications which this theory has 
undergone at the hands of his disciples. It is sufficient for 
our purpose to recognize it as a sort of zymotic element in 
the progress of medical art in this country and Europe, and 
one which, notwithstanding its activity for a considerable 
period, is now declining. 

Such was the condition of medical science and art at the 
close of the eighteenth century. A few great minds isolated 
from each other, slaves to no theory, emancipated from 
authority and dissatisfied with the results of empiricism, 
busied themselves with the accumulation of facts whose 
value they scarcely recognized, but which the future would 
gladly use. Others, and a larger number, were framers, or 
disciples, or advocates of some sort of theory, whose foun- 
dations were almost purely hypothetical. The vast majority 
of practitioners, slaves of a routine which authority had 
sanctioned, were guided solely by empiricism. The out- 
look was by no means cheerful. It was evident that if 
medical science was to advance, and a rational therapeu- 
tics ever to become possible, some new element, or force, 
must be introduced. Fortunately this new element, or force 
appeared. It was introduced by two men, John Hunter of 
England, and Bichat of France, who may be justly called 
the founders of modern physiology and pathology. 

John Hunter was one of those remarkable men who only 
appear at rare intervals, and who, if they enter the arena of 
politics, mould the fate of an empire ; if that of theology, 
change the faith of the age ; if that of science, enlarge the 
boundaries, and add to the sura of human knowledge. He 
recognized that medicine was one of the natural sciences, 
more or less intimately connected with all of them, and to 
be studied as they are by rigid and careful observation. 



8 PRACTICAL MEDICINE. 

Theory was useless, except so far as it rested upon facts. He 
regarded a knowledge of the whole organic and inorganic 
world as necessary to a just comprehension of the structure 
and functions of man. " He determined to contemplate 
nature as a vast and united whole, exhibiting, indeed, at 
different times different appearances, but preserving, amidst 
every change, a principle of uniform and uninterrupted order, 
admitting of no deviation, undergoing no disturbance, and 
presenting no real irregularity, albeit to the common eye, 
irregularities abound on every side."^ With such an object 
before him, he proceeded to collect data of every kind. The 
Hunterian Museum in London testifies to his indefatigable 
industry, and to the extent and accuracy of his researches. 
His method of investigation and of reasoning has served as 
a model for the age that followed him. His influence upon 
American medicine was not less potent than upon that of 
England and the rest of Europe. 

At the time Hunter was at work in London, his great 
contemporary, Bichat, was engaged in those researches in 
France which have rendered such inestimable services to 
physiology. Bichat died young, but he lived long enough 
to show that he was one of the world's greatest minds. 
" Between Aristotle and Bichat," says Buckle, " I can find 
no middle man." He and Hunter represent the turning- 
point in medicine from idealism, speculation, and theory, to 
accurate and close observation. His great merit lay in 
recognizing the fact that power depends on structure, and 
the additional fact that a knowledge of structures can only 
be obtained by studying the formation of the tissues that 
compose them. By following the method of Bichat, Agassiz 
was led to the remarkable discovery of the intimate con- 
nection of the tegumentary membrane of fishes with their 

' Buckle's History of Civilization in England, vol. ii. p. 446, 
Am. ed. 



PRACTICAL MEDICINE. 9 

whole organization ; by the same method, Cuvier, Owen 
and others ascertained the intimate relation of the teeth of 
an animal to its whole organization. The great discoveries 
in physiology of the past hundred years, are due to the 
fidelity with which physiologists have substantially followed 
the line of investigation marked out by Bichat and Hunter. 
The American Revolution, which was the forerunner of 
political changes of the gravest character in Europe as 
well as in America, was coincident with this new departure 
in medicine. American medical science was necessarily an 
offshoot from that of Europe. While it inherited the tradi- 
tions, the superstitions, the theories, the authority, and the 
empirical results of Europe, it also gratefully welcomed 
the independent thought and sound method of Hunter and 
Bichat. William Hunter's magnificent work on the gravid 
uterus (which for accuracy and completeness has never yet 
been surpassed) appeared in 1774. It was an admirable 
example of the results of careful investigation, and was a 
most auspicious illustration of what the new century was to 
accomplish. From that time to this the progress of medicine 
in all its branches has been of the most gratifying character. 
Although it is true, as Tennyson says, that 

"Science moves but slowly, s'.owly creeping, creeping on from 
point to point,"! 

yet, as we look back upon the past hundred years, we find 
that its march has been one of extraordinary rapidity. 
During this period, more of nature's great resources have 
been discovered, and more of her secrets found out than ever 
before. A thousand doubtful suggestions have ripened into 
facts. The telegraph, the locomotive, the steamship, the 
photograph, the spectroscope, and other discoveries more 
than we can enumerate, testify to the century's scientific 

1 Locksley Hall. 



10 PRACTICAL MEDICINE. 

activity. In politics this century has witnessed "the sepa- 
ration of America from Great Britain, the formation of the 
United States, the meeting of the Tiers-Etats, the revolu- 
tion, the downfall of the French monarchy, the republic, the 
rise of Napoleon, the mighty European wars which altered 
the face of Europe and ended with the ' Hundred Days' and 
the exile of the Corsican tyrant, the restoration of the 
Bourbons and their ruin, the Monarchy of July, the Second 
Republic, the Second Empire, the Third Republic, the 
Commune, and the humiliation of France by a power which 
but the day before had been a mere federation of incoherent 
atoms, the Septennate, the unification of Germany and of 
Italy. "^ In theology all faiths, from that of Catholic Rome 
to that of the latest Protestant sect, have been attacked, and 
they themselves have given unmistakable signs of hesitancy 
and change. The faith of Christendom has been, and is, 
crystallizing into new forms, and moving to new issues. It 
is not an extravagant assertion to say that in all this turmoil, 
change, and progress, medicine has kept abreast of the other 
natural sciences, of politics, and of theology, and has made 
equal conquests over authority, error, and tradition. 

If this statement seems extravagant, it is to be recol- 
lected that the brilliant discoveries in natural sciences and 
the arts, the great political changes, and the vacillations of 
long-established faiths to which we have referred, influence 
80 obviously the fate of nations and the aspects of civiliza- 
tion, that they force themselves prominently upon our atten- 
tion, while the progress of medicine is silent and unobserved. 
Yet the progress and changes of the latter are not less real 
than those of the former, and, perhaps, affect more pro- 
foundly than they, the development of civilization and the 
welfare of the human race. 

During the past century, medicine has been enfranchised 

1 The Nation, August 19, 1875. 



PRACTICAL MEDICINE. 11 

from superstition, quasi-charlatanism, bald empiricism, and 
speculation, and has developed into a symmetrical science, 
affiliated with the other natural sciences, studied by the 
same methods and the same appliances as they are, and, 
like them, has been planted upon the solid basis of fact 
and demonstration ; pathological anatomy, starting from 
the de Sedibus of Morgagni and the labours of Baillie, and 
illustrated by the later researches of Rokitansky, Cruveilhier, 
Yirchow, Recklinghausen, Cohnheim, and others, has become 
a fundamental branch of medical science ; obstetrics, rescued 
from the hands of ignorant midwives, has been raised with 
its allied branch, gyneecology, to its legitimate position as 
a science ; preventive medicine and hygiene, cultivated to 
an extent previously unknown, have prolonged the average 
of human life ; organic and physiological chemistry have 
been substantially created, and achieved important and bril- 
liant results ; physiology, guided by Bluraenbach, Magendie, 
Legallois, Dumas, Flourens, Johannes Miiller, Carpenter, 
Schiflf, Helmholtz, Claude Bernard, Hammond, Dalton, 
Flint, Weir Mitchell, and others, has grappled with the 
abstrusest problems of structure and life, and has revealed 
so much as to make timid people tremble at the audacity 
of its efforts ; the reflex action of the nervous system, first 
discovered by Astruc and Prochaska, has been shown by 
the admirable investigations of Sir Charles Bell, Magendie, 
Marshall Hall, Claude Bernard, Brown-Sequard, and their 
associates, to be, next to the discovery of the circulation of 
the blood, the most important addition to physiological 
knowledge that has yetrbeen made — one that has illustrated 
and explained the complex and almost inexplicable nature 
of the nervous system; the inhibitory and vaso-motor system 
of nerves has, in part, been discovered ; the velocity with 
which sensation, thought, and volition are transmitted along 
the nerves has been measured and determined ; the auto- 
matic action of the nervous system, and the position of the 



12 PRACTICAL MEDICINE. 

ganglia as centres of nervous power, have been demonstrated; 
the secrets of digestion and assimilation have been disclosed; 
by a method of exploration, which Auenbrugger and Laennec 
discovered, and Louis improved, and Skoda has shown to be 
in harmony with the laws of acoustics, the interior of the 
chest has been laid open to examination, so that the condi- 
tion of the lungs and heart can be marked out with an 
accuracy like that with which the engineer maps out the 
topography of a mountain ; the natural history of some of 
the gravest diseases has been ascertained, and means of 
preventing or curtailing them discovered ; the ophthalmo- 
scope has revolutionized ophthalmology ; the microscope 
has penetrated the secrets of structure and tissue ; the spec- 
troscope has traced the devious wandering of drugs from the 
stomach to the remotest organs of the body ; the sphygmo- 
graph has revealed the unseen and delicate movements of 
the heart and pulse ; the sesthesiometer has measured the 
sensitive power of tissue and nerve ; the dynamometer has 
recorded the force of the muscles; chemical analysis has 
traced the transformation of food into various forms of 
force, such as motion, heat, and thought ; the materia 
medica has been made rational and effective by cleansing 
it from the disgusting animal excreta and filthy compounds 
that defiled it, from the absurd farragos and useless for- 
mulas that superstition or theory had foisted into it, and 
by adding to it numerous agents that botany and chemistry 
have discovered; last of all, and most important of all, the 
grandest discovery of the ages, that which will render this 
century remarkable for all time, a class of anaesthetic agents 
has been discovered by which surgery and death even are 
deprived of half their terrors, and the physician at his will 
enabled to compel pain to disappear and distress to be quiet. 
Such has been the progress, and such are some of the 
achievements of medical science for the past century. They 
are enough to justify the enthusiastic regard in which phy- 



PRACTICAL MEDICINE. 13 

sicians hold theii* })rofessioii, and enough to deserve, as they 
have received, the gratitude of mankind. After this survey 
of the general progress of medicine for the past hundred 
years, we are prepared to estimate more correctly than 
would otherwise be possible, the part which the United 
States has taken in aid of this progress and in attaining 
these results. 

In making up our estimate, however, let us remember 
that a large amount of scientific work cannot justly be ex- 
pected of the medical profession in a new country. When 
the nation had acquired its independence, its population 
extended along a narrow coast-line from what was then 
known as Massachusetts, now Maine, to Georgia. The 
inhabitants had the Atlantic Ocean in front of them, and 
in their rear the unexplored forests, filled with aborigines, 
that stretched far away towards the Pacific. As a matter 
of necessity they were obliged to occupy themselves almost 
exclusively with the task of obtaining a secure existence in 
a new country. For the first fifty years of the nation's life, 
the necessities of the present left little leisure for the culti- 
vation of the arts and sciences. The medical profession 
were compelled by their position to devote themselves 
almost, if not quite exclusively to the practice of their pro- 
fession, and to leave scientific investigation and discovery 
to a later period. There was no superabundance of educated 
physicians. If Boerhaave, Cullen, Hunter, or Bichat had 
found themselves in America at that time, they would have 
been obliged to take care of the sick, rather than investigate 
the laws of disease and of life, and the world would not 
have heard of them as original investigators and natural 
philosophers. 

Over fifty years ago, Sydney Smith, alluding to the slow 
progress of intellectual development in the first half of our 
national existence, said in the Edinburgh Review: — 
2 



14 PRACTICAL MEDICINE. 

"The Americans are a brave, industrious, and acute people, 
but they have hitherto made no approaches to the heroic, either 
in their morality or their character. During the thirty or forty 
years of their independence they have done absolutely nothing 
for the sciences, for the arts, for literature, or even for the states- 
manlike studies of politics and political economy. ... In 
the four quarters of the globe, who reads an American book? or 
goes to an American play ? or looks upon an American picture 
or statue ? What does the world yet owe to American physi- 
cians or surgeons ? AVhat new substances have their chemists 
discovered, or what old ones have they analyzed? What new 
constellations have been discovered by the telescopes of Ame- 
ricans ? What have they done in mathematics ? Who drinks 
out of American glasses, or eats out of American plates, or wears 
American coats or gowns, or sleeps in American blankets?" 

It must be confessed there was a great deal of truth in 
his statements at that time. Naturally enough his words 
rubbed the backs of all loyal Americans the wrong way, and 
everybody cried out accordingly. At the present time we 
can read his biting language with equanimity. If the first 
half century of our national existence did not yield much to 
science and art, it produced all that could have been justly 
expected of it ; and the last half has produced books, manu- 
factures, discoveries in the arts and sciences of every kind 
that have gone over the four quarters of the globe. We 
can now fairly ask, Who does not read an American book ? 
and can point with honest pride to the services which Ame- 
rican physicians and surgeons have rendered to the world. 

When Sir Humphry Davy was asked what he considered 
to be his greatest discovery, he replied, Faraday. In like 
manner we can justly say that American physicians and 
surgeons are the best contribution of the United States to 
medical science and art. The work which the physicians of 
the first age of the republic performed, and the way in which 
they performed it, proved them to be men of whom the 
nation need not be ashamed. Men like Rush, Physick, and 



PRACTICAL MEDICINE. 15 

Chapman, of Philadelphia, Hosack, Watson, Francis, and 
Mott, of New York, the Jacksons, Warrens, and Bigclows, 
of Boston, Dudley, of Kentucky, and many others whom 
onr space does not permit us to name, are contributions to 
science of the best sort. To the example and stimulus of 
their lives and work, may be justly ascribed, to a very con- 
siderable degree, the honourable position, acknowledged 
zeal, practical judgment, and sound attainments of the Ame- 
rican medical profession of the present day. We have already 
referred to the intimate connection that existed a hundred 
years ago, and that fortunately still exists, between the 
medical science of Europe and of this country. The latter 
is not different from the former. The two are parts of a 
common whole. Even the war of the revolution scarcely 
disturbed this connection. An illustration of it is to be 
found in the fact that in the same year, 1796, in which 
Jenner vaccinated his first patient, Dr. Waterhouse repeated 
the operation in Cambridge, Massachusetts, and Dr. James 
Jackson in the neigbouring city, Boston. Another illustra- 
tion of the same thing is shown in the education of Ame- 
rican physicians. From the era of the revolution until now 
a large and constantly increasing number of American phy- 
sicians, after having completed the curriculum of medical 
study in this country, have resorted to European schools 
for the completion of their professional preparation. Dr. 
Samuel Bellingham, who graduated at the first commence- 
ment of Harvard College in 1642, afterwards obtained the 
Doctor's degree at Leyden.^ The best American education 
has always consisted in getting the best medical instruction 
that Europe and America jointly impart. Our medical 
schools are an honourable contribution to the medical work 
of the century. 

We learn from Dr. Carson's History of the University of 

' Historical Address. Dr. J. B. Beck, New York. 



IG PRACTICAL MEDICINE. 

Pennsylvania, that the first course of medical lectures given 
in Philadelphia (and probably in this country) was delivered 
by Dr. Cadwalader, prior to 1151. The first systematic 
courses of lectures on medical subjects were given in Phila- 
delphia a little more than one hundred years ago by Drs. 
Morgan and William Shippen, who were the fathers of 
medical teaching in America. The degree of Bachelor of 
Medicine was first conferred in Philadelphia in 1768, and 
that of Doctor of Medicine in New York in 1770. From 
these small beginnings sprang the medical colleges, which 
have ripened into the large institutions of Philadelphia, 
New York, and Boston, and into numerous other medical 
schools, too many we fear for the good of the profession 
and of the country, that are to be found in most of the cities, 
and connected with many of the colleges of the Union. 

These medical schools were not founded by the State, 
nor are they controlled or supported by it. A few and 
only a few of them have been scantily endowed by private 
individuals. Their support depends upon the fees derived 
from the students that resort to them. They were called 
into existence by the necessities of the times when they were 
established, and from one decade to another have been 
modified in their organization and methods of instruction 
so as to meet the demands made upon them. They are the 
natural and necessary growth of circumstances. It would 
be an interesting and easy matter to trace them from the 
small beginnings that we have indicated to their present 
proportions, and to point out the law that has governed 
their development ; but our limits permit only the briefest 
possible exposition of it. 

During the colonial period, and for some time after the 
establishment of the republic, medical students derived their 
professional training, not from schools or universities, but 
from practitioners of greater or less eminence, with whom, 
to use a technical phrase, they entered their names as 



PRACTICAL MEDICINE 17 

apprentices or students. By this arrangement they had the 
use of the library of their master, whose slielves, if not 
abundantly supplied, generally held a few books, and whose 
house usually contained in some closet or nook a few bones 
of the human frame, or perhaps an entire skeleton. These 
the student handled, examined, and studied. His opportu- 
nities for clinical study consisted in witnessing, and often 
assisting in the office practice of his master. There he pulled 
his first tooth, opened his first abscess, performed his first 
venesection, applied his first blister, administered his first 
emetic, and there first learned the various manipulations of 
minor surgery and medicine. After a time his clinical 
opportunities were enlarged by visiting with his teacher the 
patients of the latter, and becoming acquainted, not in 
hospitals but in private houses, with the protean phases of 
disease. His clinical lectures were his master's talk on the 
cases they had visited as they rode from house to house. 
After three years spent in this sort of study and practice, the 
young man was supposed to have acquired enough medical 
knowledge to enable him to commence the practice of his 
profession. In proportion as a physician or surgeon became 
eminent, students who had the means to do so flocked to 
him, and he became the centre of a medical school. His 
clinical instructions, instead of being the talks that beguiled 
the way of a long ride, were changed into formal lectures 
delivered in bis study or in some private room. Those 
who proved to be the most popular teachers, and who lived 
in the same city or neighbourhood, associated themselves 
together for purposes of teaching. Thus were founded the 
medical schools of Philadelphia and other cities. They did 
not give, and were not intended to give, a complete medical 
education, but only to supplement the instruction of private 
teachers. The courses of lectures were few in number and 
brief in extent. Students still continued to enter their 
names, and study for the major part of the year with some 

2* 



18 TRACTICAL MEDICINE. 

medical man in tlieir own neighbonrhood, and to attend 
lectures, as it was called, only three or four months of the 
year. Gradually a larger demand was made upon the 
schools ; their lecture terms were lengthened ; professor- 
ships were subdivided ; new ones were added ; hospitals 
were utilized for clinical instruction ; the schools continued 
to enlarge their curricula of study, and at length added 
summer instruction to their winter's work; museums were 
establislied ; chemical laboratories w^ere formed ; micro- 
scopical departments created ; and all the appliances were 
attached to schools that are necessary in the investigation 
of struct ure, life, and disease. This process of growth has 
not yet stopped. It is §till going vigorously on. One 
university, Harvard, requires all its medical students to go 
through a systematic course of training, under its ov/n 
supervision, by a corps of teachers of its own appointment. 
It is evident, from this brief sketch of the medical schools 
of the United States, that they are different in their organi- 
zation, and to a considerable extent in their objects, from 
those of Europe. It is equally evident that the former are 
gradually approximating the latter, though it is not likely 
that their organization, methods of instruction, and character 
will ever be the same. The fact that the European schools 
are founded and controlled by the State, and are to a large 
extent responsible to it, and that American schools are 
independent institutions, self-supporting, and responsible 
only to public opinion, necessarily impresses a distinctive 
character upon the medical schools of the two continents. 
The atmosphere of each is different ; each leads a different 
life ; and each will produce a different result. Admitting 
such to be the case, it does not follow that the medical 
schools of the United States are necessarily of an inferior 
character, or that the physicians who graduate from them 
are imperfectly educated. For the schools, except in the 
case of Harvard, just referred to, do not pretend to give a 



PRACTICAL MEDICINE. 19 

complete education, but only to supplement that which the 
student gets elsewhere. Indeed it may be affirmed that those 
who, like the apothecary of England and the Secundar Arzt 
of Germany, are charged with the medical care of the mass 
of the community in Europe, are not better equipped for the 
practical w-ork of their profession than their average Ame- 
rican contemporary. We do not mean to assert by this 
that the scientific training of our schools is equal to that 
of Vienna, Berlin, or Paris. But \ve do assert that if the 
necessities and different conditions of Europe and America 
are impartially compared, we shall find that the American 
method of medical education yields as good a practical result 
to the nation as the European method of medical education 
does to Europe. And we further assert that the flexibility 
of the American method permits of change, growth, and 
development, in correspondence with the demands of each 
succeeding age, more easily and more rapidly than is possi- 
ble with the conservative organizations of Europe. Hence 
we are not ashamed to present our medical schools, with all 
their short-comings and imperfections, as substantial con- 
tributions to the practical medicine of the century. And, 
moreover, we can justly point to graduates of these schools, 
some of whom have, and others of whom have not, been 
fortunate enough to add to their American a European 
education, as in everyway the peers of European physicians 
or surgeons. 

It was a noteworthy and fortunate circumstance,, that at 
the time of the establishment of the republic, the medical 
profession of the new nation contained a large number of 
intelligent, able, and well-educated physicians. Pre-eminent 
among these was Dr. Benjamin Rush, of Philadelphia, who 
devoted himself with enthusiasm to his profession, which he 
studied first in Philadelphia, and afterwards in Edinburgh. 
An ardent patriot, a lover of liberty, a friend of Washington, 
a signer of the Declaration of Independence, he was not only 



20 PRACTICAL MEDICINE. 

eminent as a physician, but distinguished as a philosopher 
and a scholar. Holding a high social position in a com- 
munity, noted alike for its love of the arts and sciences, and 
for the graces of social life, he contributed largely to raise 
the profession of medicine in the estimation of the community 
in which he lived, and of the whole country. During the 
Revolutionary war he rendered essential service to the army 
by a variety of professional labours, and after its close 
remained permanently in Philadelphia. Notwithstanding 
the demands of a large practice, he found or made time for 
the investigation of scientific questions, and for the publica- 
tion of the results of his inquiries. His treatise on Diseases 
of the Mind, regarded as a work full of instruction, and of 
great originality by Prof. Brown, of Edinburgh, contains 
many practical and original observations, and was a valuable 
contribution to psychological medicine. It is not yet for- 
gotten. Dr. Tuke, in his late monograph upon the Influence 
of the Mind upon the Body, quotes from it approvingly. 
Speaking of another of the essays of Dr. Rush, Dr. Tuke 
says : "Rush wrote an able essay (and when are his essays 
not able ?) on Hydrophobia, in which he assigns an im- 
portant role to the influence of fear, and an involuntary 
association of ideas. "^ Few are the observers and writers 
whose labours are remembered and words quoted for a 
hundred years after they have ceased from their work. The 
observations of Dr. Rush on Yellow Fever were extensive 
and important. They produced an impression on both sides 
of the Atlantic. Although their pathology was erroneous 
and their therapeutics atrocious, they were a substantial 
contribution to medical science by the stimulus which they 
gave to the careful and exact study of disease. When Rush 
began his lectures as Professor of the Institutes and Practice 

1 Illustrations of the Influence of the Mind upon the Body in 
Health and Disease, by Daniel Hack Tuke, M.D., Am. ed., p. 202. 



PRACTICAL MEDICINE. 21 

of Medicine in the University of Pennsylvania, diseases were 
divided, according to the nosology of Cullen, into orders, 
classes, genera, and species, containing about thirteen 
hundred and eighty-seven diseases, for each of which there 
was supposed to be an appropriate treatment. Rush rejected 
these arbitrary divisions. He paid little regard to the name 
of a disease, and founded his treatment on its nature and on 
the condition of the system. By this course he reduced his 
materia medica to a few active medicines, and so prepared 
the way for the simplification of remedies that has been 
accomplished since his day.^ 

Dr. Philip Syng Physick, a friend of Dr. Rush, and a 
favourite pupil of that great master, John Hunter, was one 
of the most accomplished and brilliant of American surgeons. 
He was not a prolific WTiter, but he found time, however, 
to study the character of yellow fever, and to publish the 
result of his observations, which were founded on post- 
mortem examinations. His researches into the character of 
this disease, together with those of Rush, La Roche, Alonzo 
Clark, Jones, and others too numerous to mention, form a 
library of yellow fever literature which will be more fully 
noticed in a subsequent essay, and which later investigators 
into its nature cannot afford to neglect. 

While Dr. Rush was pursuing his investigations in Phila- 
delphia, two men in Boston were labouring with equal zeal 
and earnestness in the cause of medical science. One of 
them, Dr. John C. Warren, devoted himself chiefly to 
surgery, and his work in that direction will be noticed in the 
surgical part of these memoirs. Apart from surgery he 
rendered a service to practical medicine that should not be 
forgotten. By his paper upon diseases of the heart, he first 
brought distinctly to the notice of the profession in this 
country that class of affections which Corvisart described in 

1 Vide Thatcher's Medical Biography. 



22 PRACTICAL MEDICINE. 

his remarkable treatise. Another and more important service 
was the foundation and endowment of the anatomical mnseum 
of the medical department of Harvard University. Under 
his care and that of Dr-. J. B. S. Jackson, who has worked 
in it and for it for more than a quarter of a century with 
rare intelligence and devotion, it has attained a completeness 
and excellence that few similar collections possess, and which 
render it one of the best contributions to the study and 
illustration of practical medicine in the country. In like 
manner, the large museums containing anatomical and 
pathological specimens, that have been collected in Phila- 
delphia and New York and other medical centres of the 
United States, are invaluable contributions to the same 
science. 

Dr. James Jackson, the second labourer to whom we 
referred, was known exclusively as a physician. He was 
one of the founders of the Massachusetts General Hospital, 
and, like Dr. Warren, was connected, with the medical school 
of Harvard College at its commencement. He was a large 
practitioner, an acute and close observer of nature, but not 
a prolific writer. In him that indefinable but substantial 
something, called common sense, was applied with singular 
success to the practice of his profession, to his clinical 
teachings at the Massachusetts General Hospital, and to 
his didactic lectures at the medical school. His report on 
typhoid fever, and Dr. Hale's paper on the same disease, 
which may be found in the Communications of the Massa- 
chusetts Medical Society, were based on their own observa- 
tions. The results at which they arrived were substantially 
those of Louis. 

Dr. Jackson's Letters to a Young Physician are models of 
sensible advice to a practitioner whether young or old, and 
whether living on one side of the Atlantic or the other. He 
never indulged in heroic practice, or in therapeutic expe- 
dients for which he could not give a reason. He believed in 



PRACTICAL MEDICINE. 23 

the conservation of nature's forces. To a large extent the 
medical profession of New England was moulded by his 
teachings and example. The impression which he made is 
not yet effaced. Such an influence, though difficult to de- 
scribe or estimate justly, is nevertheless a real contribution 
to practical medicine. Dr. Nathan Smith, a contemporary 
of Rush, Warren, and Jackson, deserves also to be remem- 
bered. He was a sound observer, w^ho, having enfranchised 
himself from the bonds of authority, delighted to study 
nature with his own eyes, and was not afraid to follow where 
she led. His essay on Typhus Fever, published in 1824, 
had the merit of pointing out the self-limited nature of that 
disease, and of showing from his own experience the futility 
of attempting to abort it, or to treat it with violent remedies. 
"I have never been satisfied," he says, "that I have cut 
short a single case of typhus that I knew to be such. 
Typhus has a natural termination like other diseases which 
arise from specific causes." He mentions with approbation 
the successful treatment of a physician who gave only milk 
and water to his patients in this complaint. "All that is 
required," is Dr. Smith's therapeutical conclusion, "are 
simple diluent drinks, a very small quantity of farinaceous 
food, and avoidance of all causes of irritation." This result, 
which he reached by his own observations more than fifty 
years ago, is the same as that which has lately been loudly 
proclaimed in England and Germany. What Dr. Smith 
calls typhus was undoubtedly typhoid fever. At the time 
he wrote, typhus and typhoid fever were confounded together 
as different forms of the same disease. It is worthy of 
remark that Dr. Smith recognized the fact, now acknow- 
ledged, that typhoid fever arises from a specific cause, and 
that one attack of it prevents a subsequent one. 

Typhoid fever prevails to such an extent in the United 
States, that our physicians enjoy ample opportunities for 
the study of it. Among those who have investigated it, 



24 PRACTICAL MEDICINE. 

none have done so with greater aciiteness and ability than 
Dr. Gerhard, of Philadelphia, or have discriminated with 
greater clearness than he the essential differences between 
typhus and typhoid. He was the first, or among the first, 
to point out these differences with scientific accuracy. He 
says himself: — 

"The advantages which I enjoyed of carefully studying the 
pathological anatomy and the symptoms of the two fevers, 
enabled me to place the question of their identity (typhus and 
typhoid], upon more settled scientific points, than had yet been 

done It is true that after the observations, which 

formed the basis of the paper which I published in 1837, were 
collected, but before their publication, Dr. Lombard, of Geneva, 
who was of course familiar with typhoid fever, stated in the 
Dublin Journal that the two diseases were different; the same 
remark I remember to have heard Prof. Andral make on the 
authority of Dr. Alison, and it was obvious to many persons that 
the description of Dr. Louis did not apply to the British typhus, 
but the points of resemblance and of difference were not settled, 
that is, they were not scientifically demonstrated."' 

The merit of having decided this important question, of 
having demonstrated the essential difference between typhus 
and typhoid fever, belongs chiefly, if not wholly, to Dr. 
Gerhard, and so far redounds to the honour of American 
Medicine. Previous to his paper, which was published in 
the American Journal of the Medical Sciences, the evidence 
as to the essential distinction between the two fevers was 
mainly speculative, or conjectural ;- he made it logical, clear, 
and unequivocal. It is only just in this connection to refer 
to the papers of Dr. J. Baxter Upham, of Boston, which, 
published many years after the appearance of Dr. Gerhard's 

' A System of Clinical Medicine. By R. J. Graves and W. W. 
Gerhard, 1848, p. 735. 

" Vide Am. Journal of Med. Sciences, vol. xix. p. 289, Feb. 1837 ; 
also, Wood's Theory and Practice of Med., vol. i. p. 373. 



PRACTICAL MEDICINE. 25 

memoir, and founded on the careful personal investigation 
of Dr. XJpham, confirmed the results of Dr. Gerhard, and 
added to our knowledge of the history of typhus. The 
observations of Dr. Tiiomas Stewardson on remitting fever 
form a valuable addition to our knowledge of that disease. 
The paper^ which embodies his views was founded on the 
clinical study and post-mortem appearances of the cases 
which came under his notice in the Pennsylvania Hospital. 
In this memoir he calls attention to changes in the liver, 
which were present in every case, and were of a character 
not met with in other diseases. These he regarded as the 
anatomical characteristic, though not the primary seat of 
the disease. 

Yellow fever has several times witliin the past century 
ravaged the Atlantic and the Gulf coast, so that our physi- 
cians have had unfortunately ample opportunities of studying 
the disease. Without detracting from the valuable labours 
of many other observers, it may be stated that to Dr. Deveze, 
then resident at Philadelphia, we are indebted for being 
foremost in asserting and maintaining the non-contagious- 
ness of yellow fever; and to Dr. Alonzo Clark, of New York, 
for showing that the pathological change, so constantly 
observed, in the liver, is due to acute fatty degeneration. 

Dr. S. H. Dickson, of South Carolina, had the opportunity 
of observing an epidemic of dengue, more than twenty-five 
years ago, of which he gave a highly interesting account. 
He considered the disease to be the same as that which 
prevailed at the South in 1828, and as the breakbone fever, 
described by Rush in 1778. The memoir is an instructive 
and valuable one.^ 

Dr. Gerhard's labours in practical medicine have con- 
tributed materially to its progress, and have given him a 

1 Am. Journ. Med. Sci., 1841 and 1842. 

2 Charleston Med. Journal, 1850. 
3 



26 PRACTICAL MEDICINE, 

deservedly high position among American medical scientists. 
Though our limits forbid an enumeration of all of his con- 
tributions, we cannot refrain from calling attention to his 
observations upon tubercular meningitis. Together with 
M. Rufz, he was the first to point out clearly the essential 
connection of hydrocephalus with tubercles of the pia mater, 
and the dependence of the former upon the latter,'^ Previous 
to his investigations, the notions of medical men with regard 
to the presence and cause of water within the cranium, 
were confused, theoretical, and consequently inaccurate. By 
many acute hydrocephalus was regarded as a cause, not as 
an effect— as an independent disease, not as a result. Dr. 
Gerhard cleared away the obscurity, supplied the missing 
links, and showed that tubercular disease of the meninges of 
the brain is a distinct malady which leads to the effusion of 
liquid there, as certainly as tubercle of the lung leads to 
purulent expectoration. 

From the time of Hippocrates until recently the treat- 
ment of effusion into the pleural cavity has been among the 
opjyrohria medicorum. With the hope of promoting the 
absorption of the fluid, the unfortunate subjects of it were 
sometimes bled, coup sur coup, sometimes salivated with 
heroic persistence, often blistered with indefatigable zeal, 
generally plied with diuretics, and by cautious practitioners 
treated on the expectant method, and all with the result of 
not interrupting the progress of the effusion. In many, 
perhaps in the majority of cases, the powers of nature were 
equal to the demand made upon her and the liquid absorbed. 
In a large number of cases, however, this fortunate result 
did not occur, and the effusion went on increasing until the 
patient was killed by mechanical pressure, or by the develop- 
ment of some disease, like tubercle or other trouble "that the 



1 Am. JourD. Med. Sci., xiii. p. 313; Wood's Practice vol. ii. p. 
675. 



PRACTICAL MEDICINE. 27 

pressure induced. More than a quarter of a century ago Dr. 
Henry I. Bowditch, of Boston, whose life has been devoted 
to the study of diseases of the chest, was impressed with the 
notion that it would be possible and safe to relieve this class 
of cases by drawing the fluid off. He made several attempts 
to do this by means of incisions into the pleural cavity. The 
results were not satisfactory. While Dr. Bowditch was busy 
with these efforts, Dt. Morrill Wyman, of Cambridge, who, 
unaware of Dr. Bowditch's views, entertained similar notions, 
successfully tapped a patient, by means of an exploring 
trocar and canula with suction-pump attached. In 1850, 
Dr. Bowditch, aided by Dr. Wyman, repeated the operation 
with equal success upon another patient, using the same 
apparatus. " That apparatus," says Dr. Bowditch, "I have 
modified somewhat, so as to make it, I think, more con- 
venient ; but the principle of the instrument remains as 
suggested by Dr. Wyman "^ 

From that time to the present, Dr. Bowditch has used 
his modification of Dr. Wyman's instrument for this opera- 
tion. In his opinion it operates more rapidly than Dieu- 
lafoy's aspirator, and quite as harmlessly and easily for the 
patient. He has operated upon patients of all ages and 
both sexes, and with almost every species of complication, 
and has never seen any permanent evil results. His own 
statement is, that he has very rarely seen anything following 
the operation, but ease to the patient. During the last 
twenty-five years he has operated 325 times upon 204 
persons. In a large number of these cases relief was not 
only afforded to the sufferer, but imminent death was 
prevented. This result is a demonstration not only of the 
propriety but of the necessity of performing thoracentesis in 

' Thoracentesis, a paper read before tlie New York Academy of 
Medicine, April, 1870, p. 6, hy H. I. Bowditch, M.D 



28 PRACTICAL MEDICINE. 

appropriate cases. Dr. Bowclitcli considers the following 
to be the indications for the operation : — 

" 1st. To save life when immediately threatened. 

" 2d. To prolong life, even when complicated with severe 

disease. 
" 3d. To shorten latent pleurisy. 
"4th. To give temporary relief merely in absolutely hopeless 

cases. 
" 5th. To relieve cases of common pleurisy which do not easily 

yield to remedies after a few weeks of treatment."' 

Thoracentesis is now regarded both in Europe and Ame- 
rica as a legitimate, safe, and necessary procedure, when 
withdrawal of fluid from the chest is indicated. It has not 
won this position, however, without difiBculty. It has had 
to run the gauntlet of opposition and of severe criticism from 
physicians and surgeons of great experience and reputation 
on both sides of the Atlantic. Trousseau advocated it ; 
Yalleix condemned it, English and American surgeons 
denounced it as unsafe and needless. That it has gradually 
made its way to its present acknowledged position, is largely 
due not only to the brilliant results of Dr. Bowditch's 
personal experience, but to the earnestness with which he 
has pressed by his pen the importance of it upon the pro- 
fession, and the clearness with which he has pointed out the 
proper method of performing it.^ 

The principle of M. Dieulafoy's aspirator, an instrument 
too well known to need description, and lately introduced 

• Thoracentesis, ut supra, p. 6. 

2 Those who are desirous of consulting Dr. Bowditcli's papers 
on the subject, are referred to the American Journal of Medical 
Sciences, April, 1852, and Jan. 1863 ; American Medical Monthly, 
Jan. 1853, New York ; Boston Medical and. Surgical Journal, May 
25, 1857. Thoracentesis and its General Results, address before 
the New York Academy of Medicine, April, 1870. 



PRACTICAL MEDICINE. 29 

to the notice of the profession, is the same as that of 
Bowditch's exploring trocar and eanula with suction-pump 
attached. The French physician's application of "aspira- 
tion" to all parts of the human body, is a brilliant generali- 
zation of the American physician's operation of thoracen- 
tesis. It is much to be regretted that M. Dieulafoy, in his 
admirable monograph on aspiration, neglected to make the 
slightest allusion to Dr. Bowditch's previous and persistent 
labours. Such a neglect on the part of M. Dieulafoy must 
have arisen either from an ignorance of Dr. Bowditch's pre- 
vious investigations, or from a desire to claim and wear the 
laurels that another had won. 

Consumption is recognized as the most terrible scourge 
of temperate climates. We are so familiar with its presence 
that we have ceased to be alarmed at its existence among 
us, although it causes from an eighth to a fifth of the total 
number of deaths in New England, and a very large 
proj)ortion of all the deatlis throughout the United States 
and Europe. The ablest intellects of the profession have 
occupied themselves, and are still occupied with the study 
of this disease, hoping to unravel completely its natural 
history and pathology, and to learn how to check its ravages 
and ameliorate the suffering it produces. Among these 
labourers Dr Bowditch holds an honoured place. His 
investigations led him to the conclusion that soil moisture 
is a large factor in the production and development of con- 
sumption. In May, 1862, he delivered an address before 
the Massachusetts Medical Society upon this subject.' 
In this address he was the first to announce what is now 
generally received as an acknowledged fact — that consump- 
tion may be produced in a family by residence on a damp soil. 
His language in the address referred to is as follows : — 

' Medical Communications of the Massachusetts Medical Society, 
vol. X. No. 2, 1862. 

8* 



30 PRACTICAL MEDICINE. 

" First. A residence on or near a damp soil, whether that 
dampness be inherent in the soil itself, or caused by percolation 
from adjacent ponds, rivers, meadows, marshes, or springy soils, 
is one of the primal causes of consumption in Massachusetts, 
probably in New England, and possibly in other portions of the 
globe. 

" Second. Consumption can be checked in its career, and 
possibly, nay probably, prevented in some instances, by attention 
to this law." 

The estimation in which these conclusions with regard to 
the influence of soil-moisture as a cause of phthisis, and of 
Dr. Bowditch's part in the investigation of it, may be 
inferred from the following statement: In 1867, Mr. Simon, 
of England, medical officer of the Privy Council, presented 
the results of Dr. Bnchanan's investigation into the death- 
rate of towns in which soil-drainage had been introduced. 
The latter had ascertained that moist towns, in which this 
had been done, had a less death-rate from consumption after 
doing it than before. In consequence of this result, Dr. 
Buchanan was ordered to investigate thoroughly the subject. 
He made "an elaborate examination of the distribution of 
phthisis as compared with variations of the soil in the three 
southeastern counties of England." Mr. Simon concludes 
from this investigation, confirmed, as he states, by Dr. 
Bowditch's previous researches in America, ''that dampness 
of the soil is an important cause of phthisis to the population 
living upon that soiP (italics as in the original). Mr. Simon 
adds, "this conclusion must henceforth stand among those 
scientific certainties on which the practice of preventive 
medicine has te rest."^ 

While these pages were passing through the press, a work 
on phthisis^ appeared from the pen of Dr. Austin Flint, of 

' Tenth Report of the Medical Officer of the Privy Council, 1868, 
p. 16. 

2 Phthisis ; its Morbid Anatomy, Etiology, etc. etc. By Austin 
Flint, M.D. Phila., 1875, p. 441. 



PRACTICAL iMEDICINE. 31 

New York, which will be gladly welcomed by the profession 
of America and of Europe. It is based on a careful record 
of six hundred and seventy cases of phthisis, which are 
grouped and analyzed with reference to the practical de- 
ductions that may be legitimately drawn from them. The 
book is written from a clinical stand-point. So far as prac- 
ticable. Dr. Flint follows the numerical method of invest!' 
gation. For the most part the cases, which he reports, 
are chronic in their character, and belong to a class remark- 
able for the uniform character of the lesions, and of the 
symptomatic events and laws which are developed by their 
clinical history. 

.In addition to this recent work on phthisis, and to other 
labours, which we have elsewhere referred to, practical medi- 
cine is indebted to Dr. Flint for a great deal of valuable 
work. His reports on continued fever, and articles in the 
American Journal of the Medical Sciences, on Tuberculosis, 
Heart Sounds, Pneumonia, Chronic Pleurisy, have all of 
them deserved and received the careful consideration of the 
profession. 

The progress of medicine, like that of all science, de- 
pends first upon the collection of facts, and afterwards upon 
a correct interpretation of them. Whoever recognizes a fact, 
however insignificant it may seem to him, and reports the 
discovery, makes a valuable contribution to science. The 
chief difficulty in the way of collecting accurate data, espe- 
cially in medicine, is that few observers are gifted with the 
power of knowing a fact when they see it. "The hardest 
thing in the world, sir, is to get possession of a fact," said 
Dr. Johnson. Most observers report what they think to 
be, not what is. Whoever contrives a new instrument that 
increases the accuracy of physical exploration, whoever dis- 
covers a new method of examination, or modifies an old 
one, by which some secret of the organization is disclosed, 
whoever demonstrates the correct explanation of any pheno- 



32 PRACTICAL MEDICINE. 

raenon of the human system, whether it be the crackling of 
bubbles in the chest or the mechanism of thought in the 
brain, whoever traces back any symptom to its cause, so as 
to make the former the pathognomonic sign of the latter, 
or whoever in any way, by microscope, analysis, scalpel, or 
experiment, reveals anything that pertains to the structure 
or functions of man, in health or disease, contributes to the 
progress of practical medicine. It would be pleasant, if it 
were possible, to collect all the contributions of this sort, 
small as well as large, that have been made by Americans 
during the past hundred years to medical science and art. 
While the parentage of many of these contributioiis is well 
known and recognized, there are many others now incor- 
porated into the body of science that cannot be traced to 
their discoverers ; their lineage is unknown. The following 
pages record some of these contributions, in addition to 
what we have already described. We are sorry that we 
cannot make the record more complete than it is. 

Dr. James Jackson, Jr., of Boston, whose premature 
death was not only a great personal bereavement to his 
friends, but a great loss to the science whose devoted stu- 
dent and servant he was, while pursuing his studies in 
Paris communicated in 1833 a paper to the Societe Medi- 
cale d'Observation on the subject of a prolonged expiratory 
sound as an early and prominent feature of bronchial respi- 
ration, and one which frequently constitutes an important 
physical sign of the first stage of phthisis.* The accuracy 
of this observation has been demonstrated by many other 
observers since the appearance of his paper. At the present 
time a prolonged expiration, when heard in the clavicular 
region of the chest, is acknowledged as one of the earliest 

J A Practical Treatise on the Physical Exploration of the Chest, 
etc. By Austin Flint, M.D., second edition. Philadelphia, page 
191. 



PRACTICAL MEDICINE. 33 

and most valuable signs to warn the practitioner of the 
insidious approach of disease. Probably few have ever 
heard even of the name of the young physician whose 
quick ear first caught the sound, and whose careful obser- 
vation connected it with the condition that produced it. 

When Laennec made his great discovery, which has revo- 
lutionized the study and indirectly the therapeutics of affec- 
tions of the chest, a variety of stethoscopes were devised to 
conduct the sounds of that region to the ear of the observer. 
Most, if not all, of these instruments were clumsy and poorly 
adapted to the object in view. They gradually fell into dis- 
use. Direct auscultation, by laying the ear directly on the 
chest, or with a single intervening bit of cloth, yielded a 
better result than the stiff, awkward wooden tube which 
Laennec employed, and which Dr. Holmes has so cleverly 
satirized. Dr. C. W. Pennock, of Philadelphia, while 
making his well-known investigations with regard to the 
heart and its diseases, discarded the stiff wooden instru- 
ment and introduced a flexible tube stethoscope.^ Its 
advantages were obvious. It did not transmit the impulse, 
but only the sounds of the heart and chest, to the ear of 
the examiner. While using this instrument the physician 
was able to explore the sounds of the heart and chest un- 
disturbed by any muscular movement. Dr. Cammann, of 
New York, improved upon Pennock's flexible stethoscoi)e 
by adopting with some modifications the double binaural 
stethoscope of Dr. Arthur Leared, of London. This in- 
strument conducts the sounds of the chest to the ear of the 
auscultator more clearly than any other, and does not con- 
duct the impulse. It is the most serviceable stethoscope 
that has yet been devised.'^ 

' Wood's Theory and Practice of Medicine, vol. i. p. 209. 
* Dr. Arthur Leared, of London, exhibited at the great Exhibi- 
tion in 1851 a double binaural stethoscope which he was the first 



34 PRACTICAL MEDICINE. 

Dr. Alfred Stille/ of Philadelphia, was among the first, 
if not the first, to call attention in print to a condition of 
the heart observed among soldiers as the result of prolonged 
and violent exertion, and now known as irritable heart; and 
Dr. Henry Hartshorne,^ in the same year, more fully de- 
scribed the aff'ection in a paper which he read before the 
College of Physicians of Philadelphia. 

In a communication forwarded in December, 1862, to the 
Surgeon-General's Office, Dr. J. M. Da Costa" called atten- 
tion to this same cardiac malady to which he gave the name 
of irritable heart, and his Medical Diagnosis, published in 
April, 18G3, contains an outline sketch of the disorder. A 
few years later^ he traced the connection of irrital)le heart 
with organic disease, and illustrated it with cases; in this 
paper, also, the inquiry took a wider scope and showed how 
exertion and strain could result in endocarditis and subse- 
quent valvular disease, and in hypertrophy. In 1871 he 
published a careful and elaborate clinical study of irritable 
heart^ based on upwards of 300 cases, in which he showed 
that irritable heart resulted from exhausting diseases, such 
as fevers and diarrhoea, and from strains and blows, as well 
as from muscular exhaustion, and further traced the connec- 
tion between functional heart disorder and organic change. 
In it was also made a valuable contribution to a more exact 

to devise. Dr. Cammann evidently got the idea of his instrument 
from that of the London physician, from which it differs in a few 
particulars. 

1 Address before the Philadelphia County Medical Society. De- 
livered Feb. 11, 1863, by Alfred Stille, M.D. 

2 Am. Journ. Med. Sciences, July, 1864. 

3 Ibid., January, 1871. 

* Sanitary Commission Memoirs, Medical Volume, New Yoik, 
1867. 

5 Am. Journ. Med. Sciences, January, 1872. 



PRACTICAL MEDICINE. 35 

knowledge of the action of remedies on the heart. ^ In 18Y4 
he^ called attention to the same affection occurring with the 
same sequelae in civil practice. In this brief monograph 
the effect of cardiac strain upon the muscular walls, valvular 
apparatus, and great vessels of the heart, is clearly stated, 
as well as the general symptoms and local signs. These 
papers give an excellent account of the disease they describe, 
and make a valuable and original contribution to practical 
medicine. 

In a recent number of the American Journal of the 
3Ied{cal Sciences,'^ Dr. Da Costa has called attention to the 
advantage of forced respiration on the part of the patient 
as an aid to the physician in diagnosticating diseases of the 
chest. We can ourselves bear testimony to the accuracy of 
his statement. Forced respiration is of especial service in 
doubtful cases, particularly when it is important, as it often 
is, to make out a differential diagnosis between bronchitis 
and phthisis. It renders other services than this, for an ac- 
count of which the reader is referred to the original article. 

Dr. Da Costa has prepared, during the past twenty years, 
a number of papers, based upon his own observations of 
disease, which are valuable contributions to practical medi- 
cine. We regret that we are unable to do more than allude 
to some of them. In addiction to those which are mentioned 
elsewhere, he published, in 1855, a memoir* on the patho- 
logical anatomy of pneumonia. In 1859 he published the 
results of some observations^ "On the occurrence of a blow- 
ing sound in the pulmonary artery, associated with affections 
of the lung; on the sounds of the artery in health, and the 
effect on them and on the heart of the act of respiration." 

^ These papers of Dr. Da Costa, which were based upon his army 
experience, have lately received a Glermau translation. 

2 On Strain and Over-action of the Heart. Toner Lecture, No. 3. 
Washington, 1874. 3 j^iy^ 1875. 

* Am. Journ. Med. tJciences, Oct. 1855. ^ Ibid., Oct. 1859. 



36 PRACTICAL MEDICINE 

In 1866 he published a paper^ on typhus fever, based upon 
tlie cases under his charge, and of course written from a 
clinical stand-point. In 1869 he gave to the profession a 
memoir on Functional Disorders of the Heart ;^ in which he 
attempted to show the real value and meaning of a cardiac 
murmur. In 1871 he recorded his observations on Mem- 
branous Enteritis,^ which, like most of his other observations, 
were based on a careful clinical study of the disease, and 
present a complete account of it. 

The importance of distinguishing the variations of pitch 
elicited by percussion is now universally recognized as an 
aid in ascertaining the condition of the organs in the chest. 
There are cases in which these variations afford the earliest 
clew to commencing disease ; and sometimes when tlie signs 
are nearly evenly balanced it throws the vote which decides 
the verdict. The profession are indebted to Dr. Austin 
Flint, of New York, for calling their attention to this sub- 
ject, at least in this country. Dr. Flint's statement of the 
value of variations of pitch in exploration of the chest, and 
the practical inferences from them which his acute observa- 
tion and large experience suggested, and the investigations 
which led him to his conclusions in this matter, may be found 
in an essay which received in 1852 the prize of tlie American 
Medical Association. The combination of percussion and 
auscultation, or auscultatory percussion, as described and 
employed by Dr. Alonzo Clark, of New York, is undoubtedly 
well adapted to determine with ease and accuracy the 
boundaries of the heart.* This sort of cardiac examination 
cannot be made accurately without the aid of Cammann's 
stethoscope. When we recollect the method by which Piorry 
used to map out the boundaries of the heart, a task which 

* Am. Jouru. Med. Sciences, Jan. 1866. 

2 Ibid., July, 1869. « Ibid., Oct. 1871. 

* New York Medical Journal, July, 1840. Flint, on Diseases 
of the Heart, Second edition, p. 43, 1870. 



PRACTICAL MEDICINE. 37 

we liave often seen the distinguished French auscultator 
undertake in the wards of his own hospital five-and-twenty 
years ago, we are forcibly struck with the advance which 
has been made during the past quarter of a century in the 
physical examination of the chest. 

There are few practitioners who have not sometimes been 
puzzled to distinguish between the solidification of pneu- 
monia and the effusion of pleurisy. The differential diag- 
nosis between these two conditions is sometimes a matter of 
great delicacy and difiBculty. Here we are again indebted to 
Dr. Flint, of New York, for enabling us to solve the difiBculty 
with comparative ease. He showed that by mapping out 
the lobar dulness which exists in pneumonia, the inflamma- 
tory condition of the lung could be discriminated from the 
effusion in which no such limited dulness exists. Though it 
does not fall within the scope of this paper to touch at all 
upon the subject of American medical literature, we cannot 
refrain from referring in this connection to the masterly 
digests of the vast number of memoirs, monographs, and the 
like, upon the subject of pneumonia, and perhaps we should 
add yellow fever, which have appeared from the pens of Dr. 
La Roche and Dr. Flint. They are substantial contributions 
to practical medicine. The mechanism by which the crepi- 
tant r41e of pneumonia is produced is not yet perfectly 
made out. The explanation of it, given by Dr. E. Carr, of 
Canandaigua, N. Y., has been accepted by pathologists as 
probable, if not fully demonstrated, and deserves mention. 
Dr. Carr suggests that the crepitant sound is produced by 
air rushing into and distending the bronchial vesicles which 
hud been previously glued together by tenacious mucus. 
For a full exposition of his views our readers are referred to 
his original article.^ 

J American Journal of Medical Sciences, New Series, vol. iv. p. 
360, 1842. 
4 



38 PRACTICAL MEDICINE 

Croup, a name dreaded alike by physicians and mothers, 
was for centuries the generic term of several inflammatory 
affections of the throat that were confounded together. 
Gradually these different affections have been discriminated 
from each other and have received different names. The 
term croup, or as some prefer to call it, membranous croup — 
the diphtherite of Bretonneau — is now restricted to an 
inflammation of the upper part of the air passages attended 
with the formation of a membrane. The membrane is re- 
cognized as an essential part of the disease. Richard Bayley, 
Surgeon of New York, recognized the distinctive charac- 
teristics of this affection as long ago as 1781. In a letter 
to William Thornton, M.D., of London, which afterwards 
appeared in the New York Medical Rejyository,^ he points 
out the difference between angina trachealis and putrid sore 
throat, or, in modern terms, between membranous croup and 
diphtheria. His observations were founded upon autopsies 
of the two diseases, and therefore rested on an anatomical 
basis. It is unfortunate that his views did not attract more 
attention, and make a more permanent impression than they 
did. They w^ere corroborated by Dr. Peter Middleton, of 
New York, who satisfied himself that croup "is totally dis- 
tinct from the malignant sore throat; it is not of itself of a 
nature malignant or infectious as the putrid sore throat may 
often be." These views were put forth nearly ninety years 
ago, and have been confirmed only within a comparatively 
recent period. Among those who have studied the natural 
history of this disease, Dr. John Ware deserves honourable 
mention. His memoir on the history and diagnosis of croup 
contributed materially to the accuracy of our knowledge of 
it and to its correct treatment. His paper was based upon 
a careful study of the cases which came under his own 
observation. He was satisfied that membranous croup and 

1 New York Medical Repository, vols. xii. and xiv., 1809 and 1811. 



PRACTICAL MEDICINE. 39 

inflammatory croup were not different stages of t!ie same 
disease, but distinct maladies, differing from each other in 
their character and prognosis, and requiring a different 
treatment. His reasons for believing in the essential differ- 
ence of the two diseases are stated in the following moderate 
language : " The very great preponderance of fatal results in 
the membranous croup and a similar preponderance of 
recoveries in the inflammatory, and the evidence which exists 
that in a few cases of recovery from the former the membrane 
has been found, and in the few cases on record of death from 
the latter that a membrane has not been found, afford strong 
reason for believing that the diseases are essentially differ- 
ent."^ Dr. Ware regarded the membrane in membranous 
croup more as a result of a peculiar kind of inflammation 
than as the essential part of the disease. As to the prog- 
nosis in the two forms, he inferred from his observations 
"that the only form of croup, attended with any considerable 
danger to life, is that distinguished by the presence of a 
false membrane in the air passages." To this he added the 
following remark : "The existence of this membrane in the 
air passages is in a very large proportion of instances indi- 
cated by the existence of a similar membrane in the visible 
parts of the throat." As far as treatment is concerned, he 
was satisfied that inflammatory croup gets well sooner by 
the aid of mild and soothing applications, such as emollient 
gargles, light diet, opiates, and occasional poulticing ex- 
ternally, than by heroic treatnient, such as opening the 
jugular vein, free leeching, antimonial and other emetics and 
violent cathartics, with which this disease has been so fre- 
quently and unfortunately combated. In like manner it was 
a fair induction from his cases that membranous croup is 
more likely to be aggravated than relieved by violent appli- 

1 Contributions to the History and Diagnosis of Croup, hy John 
Ware, 1842. 



40 PRACTICAL MEDICINE. 

cations. He found that the inhalation of warm vapour, an 
even temperature, and enforced quiet more frequently led to 
the resolution of the inflammation and consequent detach- 
ment and expulsion of the membrane than the lancet or 
caustic or other extreme measures. When we consider that 
these observations were made, and the record of them and 
deductions from them published more than thirty years ago, 
and observe how nearly they represent our present knowl- 
edge of the history, prognosis, and treatment of croup, we 
cannot resist the conclusion that Dr. Ware was largely in 
advance of his time in comprehending the nature of croupal 
affections, and that his observations on these affections were 
a valuable contribution to practical medicine. The minute 
studies of recent German investigators in this direction have 
substantially confirmed Dr. Ware's earlier views. 

Abernethy was in the habit of urging with great earnest- 
ness the importance, especially so far as treatment is con- 
cerned, of the constitutional origin of local diseases. The 
late Dr. Horace Green, of New York (who achieved such 
a large notoriety as a specialist in diseases of the throat), 
insisted with equal emphasis upon the local origin of con- 
stitutional diseases. His treatise on diseases of the air 
passages might be regarded without injustice as a defence 
of such a thesis. Its real object was, of course, to present 
and defend Dr. Green's peculiar views. Although his 
pathology and therapeutics were severely, and to a large 
extent, not unfairly criticized, both in America and Europe, 
yet it is not to be denied that his observations contributed 
to advance our knowledge of the throat and its maladies. 
They not only stimulated inquiry, but showed how far local 
applications could be carried into those regions, and to what 
extent the tissues would bear cutting, slashing, and burning. 
Dr. Green was a bold and skilled operator, an heroic thera- 
peutist, and was sometimes charged with magnifying his 
office. These qualities enabled him to do what others would 



PRACTICAL MEDICINE. 41 

have shrunk from. We must remember that the laryngo- 
scope, which has revolutionized our notions of the throat as 
much as Laennec's discovery did our notions of the chest, 
was not known when Dr. Green was studying and treating 
the air passages. Since the laryngoscopic mirror has 
rendered visible parts of the throat that were previously 
invisible except after 'dissection on the dead body, and 
has rendered possible a variety of local applications and 
operations that would not previously have been ventured 
upon, it has been ascertained that Dr. Green's attempts to 
reach and act upon the glottis, epiglottis, larynx, even 
down to and below the bifurcation of the bronchi, were 
legitimate. Czermak, Mackenzie, and their disciples have 
carried the local treatment of the throat and air passages 
much further than Dr. Green ever attempted, but he deserves 
the credit of having opened the way into a region which later 
physicians with better appliances and ingeniously constructed 
instruments have explored with such success. 

Autumnal catarrh, commonly called hay fever, from some 
supposed, but improbable and unproved connection with 
hay as its cause, has been recognized as a distinct disease 
only within a comparatively short period. It has un- 
doubtedly been one of the ills flesh is heir to from time im- 
memorial, but has been confounded with ordinary catarrh, 
asthma, and the like. Gradually its distinctive features have 
been made out. Since it has obtained the status of a distinct 
disease, it is surprising how many people, both in this country 
and in Europe, have been found to be sufferers from it. Few 
or none die from it, and the consequent inability to obtain 
post-mortem information makes our knowledge of its patho- 
logy more or less conjectural. Dr. Morrill Wyman, of 
Cambridge, whose interest in the disease may possibly be 
heightened by the fact that he is personally one of its 
victims, has contributed more than any other observer that 
we are acquainted with, to a correct knowledge of its 

4* 



42 PRACTICAL MEDICINE. 

natui'ul history and treatment. His treatise on autumnal 
catarrh^ is a classical one of its kind. He has pointed out the 
distinctive characters which separate it from other catarrhs, 
its limited duration, its remissions, intermissions, and whim- 
sical variations, its intractability to the action of drugs, the 
fact that certain regions are free from it and that migration 
to these regions relieves the suflFerer almost immediately. 
He has made several experiments with regard to its etiology, 
which, while they do not demonstrate its cause, indicate the 
direction of study which will probably lead to the discovery 
of its cause, and has shown that '* the disease has more of a 
general than local character, and falls especially upon the 
nervous system." By long and careful observation he has 
ascertained that the regions of this country which are free 
from the disease, the places of refuge for the catarrhly 
afflicted, are the northern side of the White Mountains in 
New Hampshire ; Mount Mansfield, in Vermont, and its 
immediate neighbourhood; the Adirondacks, in New York; 
the Ohio and Pennsylvania plateau, including the high range 
of land in New York from the Catskill Mountains to the 
western border of the State; the island of Mackinaw; the 
northern side of the great lakes in Canada; tracts of land 
beyond the Mississippi, at St. Paul and in Minnesota ; the 
Alleghany Mountains at Oakland, and other elevated points 
of the same region ; the high lands of the interior of Maine ; 
and the whole sea-coast from St. John's quite round to 
Labrador. It thus appears from Dr. Wyman's observations 
that the regions of safety for the afflicted are by no means 
small ; and that in this disease climate most effectually sup- 
plements the action of drugs. 

It is undeniable that during the past century, and particu- 
larly during the past fifty years, medical science has made 
great and satisfactory progress in acquiring an intimate and 

1 Autumnal Catarrh (Hay Fever), New York, 1872. 



PRACTICAL MEDICINE. 43 

accurate knowledge of the natural history, pathology, and 
appropriate treatment of diseases of the chest and air pas- 
sages. When we consider the contributions to this pro- 
gress made by the American physicians, Bowditch, Gerhard, 
Pennock, Da Costa, Alonzo Clark, Austin Flint, Green, 
^Vare, Wyman, and others whose labours we have so im- 
perfectly described, and by other physicians whose contribu- 
tions we have not time to mention, we can point with honest 
pride to the honourable record of service rendered to the 
progress of this department of medical science by America. 
In our allusion to Dr. Nathan Smith's papers on fevers, 
we referred to his conjecture, or belief, that typhoid fever 
could not be broken up by treatment; that it was in fact a 
self-limited disease. The best observers at that time were 
beginning to reach that conclusion. Louis' observation of 
typhoid fever led him. to entertain the same notion ; Andral's 
study of typhus led him, so far as that disease is concerned, 
to the same conviction. Doubtless there were other observers 
scattered here and there in Europe and America, who had 
learned to recognize the fact that some diseases were self- 
limited in their course, but such was not the common view. 
Dr. Jacob Bigelow, in a paper published in 1822,^ was the 
first or among the first to make a clear and distinct state- 
ment — a grand generalization from the study and observa- 
tion of disease — that self-limitation is one of the laws that 
govern the course of a large number of morbid processes. 
This paper is not only a statement of the law, but a demon- 
stration of its truth. Dr. Bigelow did not claim absolute 
originality for his views, for in his paper he says : " I am 
aware that some of the most distinguished French patho- 
logists of the present day incline to the opinion that many 
acute diseases, or at least inflammations, are incapable of 
being shortened in their duration by art. The opposite 

' Mass. Med. Soc. Conim. vol. iii. 



44 PRACTICAL MEDICINE. 

opinion prevails very generally in this country and in Eng- 
land, and it would be premature to consider the question as 
decided, until it has been submitted more extensively to the 
test of comparative numerical results." That test has since 
been applied, and has resulted in confirming the accuracy 
of Dr. Bigelow's statement. We do not partake of the 
enthusiasm of a medical friend, who said that he would rather 
have written Dr. Bigelow's paper on self-limited diseases 
than to have been the victorious commander at Waterloo. 
Still the paper was one of those clear and distinct statements 
of a truth, or rather of a natural law, which, by directing 
the attention of physicians in this country and elsewhere to 
a neglected and unrecognized fact, was an admirable con- 
tribution to the progress of practical medicine. It has un- 
doubtedly saved a great many lives by preventing useless 
and violent medication, and has saved many more by turning 
the attention of practitioners to the support of the system, 
while disease was passing through its appointed orbit. The 
observation of every year since the appearance of Dr. Bige- 
low's paper has lengthened the catalogue of self-limited 
diseases. Science is beginning to learn that the laws which 
govern morbid processes are not less immutable than those 
which control the planets ; and that therapeutics to be 
rational and successful must conform to these laws, and not 
undertake to neglect or thwart them. 

A superficial observation would lead to the belief that 
delirium tremens could not be an illustration of the law 
of self-limitation in disease. Formerly, according to the 
popular and perhaps universal sentiment of the profession, 
delirium tremens was an affection that required prompt and 
active interference. In conformity with such a notion, the 
heaviest batteries of the materia medica were turned upon 
the unfortunate victims of this malady, and a rapid and 
unrelenting discharge of drugs kept up upon them. Opium, 
emetics, assafoetida, warm baths, digitalis, hyoscyamus. 



PRACTICAL MEDICINE. 45 

valerian, prussic acid, wormwood, spirits, sulphuric ether, 
hops, borax, and other articles were prescribed, separately 
or in combination, with extraordinary activity and zeal. 
Dr. John Ware, of Boston, was not satisfied with the results 
of such active and indiscriminate fighting. He accordingly 
determined to study the natural history of the disease. In 
1831, he published a paper^ on delirium tremens, founded 
exclusively upon a considerable number of cases of it which 
had occurred under his own observation. This memoir is an 
original one of marked value, and of special clinical interest. 
In it the expectant treatment during the paroxysm is highly 
spoken of, and its result is stated to be a termination of the 
attack "at a period seldom less than sixty, or more than 
seventy-two hours, from the commencement of the paroxysm." 
This result of the expectant treatment as demonstrated by 
his observations, he compared with the results of other kinds 
of treatment, as reported by those who have tried them. 
The inference from the comparison is not in favour of active 
interference. " I am satisfied, therefore," says Dr. Ware, 
"that in cases of delirium tremens the patient, so far as the 
paroxysm alone is concerned, should be left to the resources 
of his own system, particularly that no attempt should be 
made to force sleep by any of the remedies which are usually 
supposed to have that tendency ; more particularly that this 
should not be attempted by the use of opium." Since the 
introduction of bromide of potassium and chloral hydrate as 
hypnotics, patients with delirium tremens have been enabled, 
by the aid of these agents, to pass more comfortably through 
the paroxysms of the malady, but it is doubtful whether the 
period of sleeplessness has been curtailed by them. The 
observation of more than forty years, that have elapsed 
since the appearance of Dr. Ware's paper, has confirmed 
the accuracy of his statements, and has also shown that 

' Transactions of the Mass. Med. Society, Boston, 1831. 



46 PRACTICAL MEDICINE. 

delirium tremens is one of the diseases included bj the law 
of self-limitation. Dr. Kuhn, of Philadelphia, treated this 
malady, nearly a century ago, after the expectant fashion^ 
in a novel way, by " confining the patient in a dark cell, 
and leaving the disease spontaneously to work itself off." 
After an extensive trial of this method he was satisfied that 
it yielded a good result. He experimented also with the 
opium treatment^ in 1783. The observations of Dr. Ware, 
which have just been cited, confirmed the earlier results of 
Dr. Kuhn. 

Medical science is largely indebted to Dr. Austin Flint, 
of New York, an observer whose acquirements, accuracy of 
observation, and soundness of judgment have justly earned 
for him a European as well as an American reputation, for 
ascertaining that an affection so apparently irregular in its 
course, and so generally supposed to require active treat- 
ment as rheumatism, belongs to the class of self-limited 
diseases. A recent paper^ of his contains a series of clinical 
observations on the treatment of acute articular rheumatism. 
It is not to be forgotton that Oppolzer instituted a similar 
inquiry some years ago with regard to the same disease. 
The distinguished German physician felt justified by his 
observations in asserting that drugs might mitigate the 
distress, and prevent or relieve some of the complications of 
rheumatism, but could not shorten its natural termination. 
Dr. Flint's observations confirm those of Oppolzer, and indi- 
cate that the rational treatment of this intractable affection 
consists in keeping it within its natural orbit, and not in 
vain efforts to curtail it. 

Recent investigations, especially those of Charcot in 
locomotor ataxia, and those of Weir Mitchell on injuries 

' Phila. Journ. Med. and Phjs. Sciences, iii. 242. 
2 N. A. Med. and Surg. Journ., iv. 235. 
8 Am. Journ. Med. Sciences, July, 1SG3. 



PRACTICAL MEDICINE. 47 

of nerves, have disclosed an unexpected relation between 
certain derangements of the spine and swelling of the 
joints. More than forty years ago Dr. J. K. Mitchell, of 
Philadelphia, was led by rheumatic or rather by rheumatoid 
syaiptoms, in a case of caries of the spine, to suspect a 
connection between the medulla spinalis and the supposed 
rheumatism. He collected a number of cases besides those 
which came under his own observation, and founded upon 
them two papers,^ one of which appeared in 1831, and the 
other in 1833. His observations were original and valuable. 
Their author did not follow them to the legitimate conclu- 
sions, which later investigations show might have been drawn 
from them. Nevertheless, as far as he went, he was in 
advance of his time. Dr. Flint has also recently published 
a paper on the natural history of acute dysentery, founded 
upon a series of cases observed and treated by himself One 
of the practical conclusions which he drew from the study of 
these cases is that dysentery " is a self-limited disease, and 
its duration is but little, if at all, abridged by methods of 
treatment now and heretofore in vogue. "'^ 

In March, 1864, Dr. John 0. Dalton read a paper^ before 
the Academy of Medicine in New York, giving an account 
of some observations which he had previously made on 
Trichina Spiralis. In 1869 he supplemented this paper by 
another one* on the same subject. These two papers not 
only contain an account of what was previously known with 
regard to this curious parasite, but a number of interesting 
original observations upon trichinse taken from trichinous 
meat, and also upon those taken from man. The two 
papers are valuable contributions to the natural history of 

^ Amer. Journ. Med. Sciences, May, 1831, and August, 1833. 
2 Ibid., July, 1875. 

' Transactions of the New York Academy of Medicine, 1864. 
* Medical Record, N. Y., April 15, 1869. 



48 PRACTICAL MEDICINE. 

tricliinse and to the best method of protecting the system 
from their ravages. 

To arrange a series of facts so as to compare them with 
each other, ascertain their mutual relations, draw from them 
legitimate deductions, and thus demonstrate some unknown 
truth, or confirm one previously recognized, is to render as 
distinct a service to the cause of science as to collect the 
facts themselves. Indeed, the collection of facts without 
comprehending their relations to each other and to the 
whole world of facts, is a barren service. 

Dr. Oliver Wendell Holmes, whose brilliant reputation as 
poet and novelist must not make us forget that he is also 
physician and anatomist, prepared a paper^ in 1843 upon the 
important subject of the contagiousness of puerperal fever, 
a paper which belongs to the former of the two classes of 
contributions to medical science that we have just mentioned. 
The practical point which Dr. Holmes illustrated and proved 
is that "the disease known as puerperal fever, is so far con- 
tagious as to be frequently carried from patient to patient 
by physicians and nurses." The merit of this paper consists, 
not only in the collection and arrangement of the evidence 
that had accumulated upon an important matter, but in the 
logical and forcible presentation of the argument which the 
evidence legitimately warranted in favour of the point he 
maintained. Its value as a contribution to practical medi- 
cine is shown not only by the influence it exerted in this 
country, but also by the fact that Copland and Ramsbotham 
referred to it in approving terms, and that the Registrar 
General of England made use of it in his fifth annual report. 
It is interesting to note, that at the time when Dr. Holmes' 
paper appeared, two works that were largely, if not almost 
universally appealed to, as authorities in this country, viz., 

1 This paper was published in the New England Journal of 
Medicine and Surgerj for April, 1843. 



PRACTICAL MEDICINE. 49 

Dewees^ Treatise on the Diseases of Females, and the Phila- 
deljohia Practice of Midwifery^ by Dr. Qi. D. Meigs, both 
taught the non-contagiousness of puerperal fever. At the 
present time the question may be considered settled in 
favour of the view which Dr. Holmes deduced from the 
facts which were then in his possession. 

Not long after the appearance of Dr. Holmes' paper Dr. 
Samuel Kneeland, Jr., published one' on the connection 
between puerperal fever and epidemic erysipelas, in which 
he maintained that the two diseases are similar. His paper 
presented the evidence in favour of this view. Within the 
past year another American physician. Dr. Thomas C. Minor, 
of Cincinnati, has published a work^ in which he enters into 
a careful and elaborate examination of the relations of 
puerperal fever to erysipelas, based upon the facts obtained 
from the census of the United States for 1870. Among 
the conclusions which Dr. Minor felt warranted in drawing 
from the evidence before him are the following: — 

1st. That there is an ultimate connection existing between 
child-bed fever and erysipelas, and that in any place where 
erysipelas is found there will be found puerperal fever. 

2d. Physicians attending child-bed fever cases and ery- 
sipelas at the same time were most unfortunate in their 
practice 

3d. Physicians having large obstetric practices, but who 
are known to be believers in the close connection of child- 
bed fever and erysipelas, returned few death certificates 
from either cause. 

4th. Epidemic erysipelas is invariably associated with an 
outbreak of epidemic child-bed fever, or vice versa. The 
London Practitioner for August, 1875, in a notice of Dr. 

' Am. Journ. Med. Scieuces, April, 184(3. 

2 Erysipelas and Child-bed Fever, bj Thomas C. Minor, M.D., 
Cincinnati, 1874. 
5 



50 PRACTICAL MEDICINE. 

Minor's work, says: "If it be asked what was the bond of 
the connection between erysipelas and child-bed fever here 
maintained, the same conclusion is suggested by the American 
as by the English experience, namely, chiefly the doctor and 
the nurse.''^^ 

Notwithstanding the care with which Asiatic cholera has 
been studied by competent observers in almost every part 
of the world, its pathology and treatment have not yet been 
clearly made out. We are indebted to Dr. William E. 
Horner, the distinguished anatomist of Philadelphia, for 
discovering one important fact with regard to it. The 
origin of the rice-water discharges in that disease had long 
been an unsolved problem. Dr. Horner first detected the 
fact that in cholera the whole epithelium is stripped from the 
small intestines, and that the turbid rice-water dejections, 
which are so characteristic of this disease, result from this 
peculiar stripping of the mucous membrane. For an account 
of Dr. Horner's researches, which were made with his sin- 
gular patience and accuracy, and which led him to the dis- 
covery of this pathological fact, we must refer to his original 
article,^ Here we can only call attention to his early recog- 
nition of it. His recognition and published record are 

' The different departments of medical science uaturally and 
inevitably run into each other to such an extent that it is impos- 
sible to draw a distinct line of demarcation between them. Their 
boundaries are fluctuating and indeterminate. It might be justly 
said that these references to puerpen-al fever belong more properly 
to the Report on Obstetrics and Gynaecology which will appear 
hereafter, than to one which is concerned only with practical 
medicine. On the other hand, erysipelas comes chiefly under the 
eye of the general practitioner. The mutual relations of erysipelas 
and puerperal fever may, therefore, be discussed as appropriately 
under the head of Practical Medicine as under the head of Obstet- 
rics. Neither the geneial practitioner nor the obstetrician can 
afford to neglect them. 

2 Am. Journ. Med. Sciences, vol. xxi. page 289. 



PRACTICAL MEDICINE 61 

illustrations of our previous statement, that American 
journals contain accounts of numerous isolated facts per- 
taining to the various branches of medicine which show that 
American physicians have not been idle scientific observers. 
The same observer instituted in 1827 a series of original 
and interesting inquiries into the healthy and diseased ap- 
pearances of the gastro-enteric mucous membrane. He 
endeavoured to ascertain the healthy condition and appear- 
ance of this membrane, its appearance in congestion from 
the agonies of dying, and its appearance in genuine red 
inflammation. His conclusions were, that congestion is not 
an active condition of the part affected, but is most fre- 
quently the result of mechanical impediment to the venous 
circulation.^ Dr. Horner also instituted an inquiry into the 
anatomical characters of Infantile Follicular Inflammation 
of the Gastro-intestinal Mucous Membrane, and into its 
probable identity with cholera infantum. This paper pointed 
out very clearly the changes which occur in the follicular 
apparatus.* Dr. Horner's labours in other directions, which 
have given him such a distinguished place among American 
anatomists, do not fall within the scope of this essay. 

The investigations of Dr. John Neill, of Philadelphia, on 
the mucous membrane of the stomach, made a quarter of a 
century ago, were original, and added to our knowledge of 
the structure of that organ. The results of his investiga- 
tions were given to the public in a paper^ entitled " On 
the Structure of the Mucous Membrane of the Stomach," 
which may be consulted at the present day with advantage. 

The liver has always presented an interesting and difficult 
field of study to the physiologist, the pathologist, and the 
practitioner. The problems which it offers to the student 
are far from being solved at the present day. While there is 

' Amer. Jouni. of Med, Sciences, vol. i. 1827. 

2 Ibid., vol. iii. 1828. 3 Ibid., .Jan. 1851. 



52 PRACTICAL MEDICINE. 

an agreement on many and important points among medical 
scientists, there are many others which are still debated. 
Some of the ablest living physiologists and histologists, like 
Claude Bernard, Ch. Robin, Kolliker, Schiff, and others* 
have been led by their investigations to entertain and defend 
different, and, sometimes, opposing views of the intimate 
structure and functions of the liver. American physicians 
and physiologists have not been mere spectators of these 
efforts to disentangle and clear up such knotty questions. 
Dr. Leidy's paper on the comparative structure of the liver^ 
is the most exact and complete essay in the department of 
microscopic anatomy which has appeared in any American 
medical journal, and is a most valuable contribution to our 
knowledge of the liver. 

To this we may add the. researches of Dr. Austin Flint, 
Jr.,^ of New York, upon cholesterine, which have thrown a 
good deal of light upon one of the obscure functions of the 
liver. According to him, says Kiiss,^ " the excrementitial 
product formed by the disassimilation of the bruin and of 
the nerves, at the expense of protagon, is represented by 
cholesterine, separated from the blood by means of the liver, 
and then thrown into the intestinal canal. This view is 
based upon a number of experiments which show, moreover, 
that the excretion of cholesterine is in direct ratio with the 
nervous activity. The common expression, to feel bilious* 
seems justified by one of the elements of the bile, viz., choles- 
terine." The connection between derangements of the liver 
and disturbance of the functions of the brain has long been 
clinically recognized. Whatever explains the mechanism of 
this connection, is as much a contribution to practical medi- 
cine as to physiology. Professor John C. Dalton, of New 

' Amer. Journ. of Med. Sciences, Jan. 1848. 

2 Ibid., Oct. 1862. 

3 Lectures on Physiology, by Professor Kiiss, translated by Rcbert 
Amory, M.D., p. 27. 



PRACTICAL MEDICINE. 53 

York, has rendered efficient service in this direction by his 
efforts to explain the glycogenic function of the liver. Schiff 
and Pavy maintain that the sugar found in the liver is a 
post-mortem product. Dr. Dalton, whose experiments were 
conducted, to say the least, with as much care, ingenuity, and 
rapidity as those performed by Schiff, Pavy, or Bernard, 
demonstrated the presence of sugar in the living liver. The 
practical relation of his experiments and their result to the 
question of diabetes is obvious. 

Our present knowledge of gastric digestion is largely due 
to the opportunities, which gastric fistulas have afforded 
physiologists for the inspection of the living stomach, or 
more exactly, of the stomach at work. Medical science owes 
a debt of gratitude to Dr. William Beaumont, surgeon in 
the U. S. Array, for leading the way in this method of ex- 
periment and observation. The subject of his experiments 
was Alexis St. Martin, a French Canadian voyageur, who 
was wounded in 1822, in such a way as to produce a per- 
manent gastric fistula. Fortunately Dr. Beaumont was able 
to keep St. Martin under his observation for a long time. 
By means of the fistula he made a series of extended, careful, 
and valuable experiments upon the digestibility of different 
articles of food and drink, and noted the behaviour of the 
stomach in a state of quiescence and in one of activity. His 
experiments and the inferences which he drew from them 
are so well known that it is unnecessary to describe them 
here. They are not only valuable in themselves, but opened 
the way to a method of investigation, which, both in this 
country and in Europe, has yielded in the hands of various 
physiologists important results to practical medicine.^ 

Dr. J. J. Woodward, now in Washington, D. C, published 

' The Pbysiologj of Digestion, with Experiments on Gastric 
Juice, by William Beaumont, M.D., U. S. A. The first edition of 
this work was published in 1833. 

5* 



54 PRACTICAL MEDICINE, 

in 1864 a work on tlie Chief Cam]) Diseases of the United 
States Armies as Observed during the Present War. It is a 
practical contribution of great value to military medicine, 
and can be studied with profit by physicians in civil practice. 
Its account of camp diarrhoea and malarial fever are of 
especial interest. 

No department of medical science has been studied with 
greater earnestness than that of the nervous system. Its 
importance justifies the labour and time expended upon it. 
Among American physicians and physiologists who have 
endeavoured to unravel its intricacies, Dr. S. Weir Mitchell, 
of Philadelphia, is facile princeps. He has done much 
valuable work in this direction, to wliich we can only briefly 
refer. 

During our late civil war Dr. William A. Hammond, of 
New York, himself eminent as a neuro-])hysiologist and 
neuro-pathologist, established, at the time he was Surgeon- 
General of the United States Army, a hospital for nervous 
diseases, and invited Dr. Mitchell to take charge of it. Drs. 
Morehouse and Keen were associated with Dr. Mitchell in 
the management of the hospital. The experience acquired 
in this hospital by the gentlemen in charge of it led to the 
publication of a number of communications by them on 
nervous affections. One of tiie most important of these 
was entitled "Gunshot Wounds and other Injuries of 
Nerves," published in 1864. In the language of Dr. 
Mitchell, " this volume describes at length all the primary 
and secondary results of nerve wounds, and especially many 
hitherto undescribed lesions of nutrition, as well as a novel 
form of burning pain previously unknown, as a consequence 
of gunshot wounds. There are also full details of treatment, 
and a report of thirty-one cases of nerve lesions." With 
regard to this book, the Edinburgh Medical Journal says 
that it is valuable to practical surgeons, from the many de- 
tails of treatment which it contains, and that it is "specially 



PRACTICAL MEDICINE. 55 

interesting to pbysioloirists and neuro-pathologists, from 
the extreme care with which the cases appear to have been 
taken, and the exactness and minuteness of the descriptions 
of the effectsof the injuries on motion and sensation," "The 
glossy skin," previously noticed by Paget, is here described 
in detail, and shown in many cases to be connected with the 
peculiar burning pain that is noticed. The same observers 
put forth a paper on Reflex Paralysis in 1864. In this 
paper a novel theory of "shock" from injuries is set forth, 
and cases related where a ball-wound of one limb caused 
paralysis of remote parts of the body. 

The monograph on gunshot wounds was supplemented 
by Dr. Mitchell in 1871, by a memoir on "The Diseases of 
Nerves resulting from Tying." This wns published in the 
medical volume of the Reports of the U. S. Sanitary Com- 
mission. In 1872 Dr. Mitchell published a work upon In- 
juries of Nerves and their Consequences, which he dedicated 
to Dr. Wm. A. Hammond, "whose liberal views," says Dr. 
Mitchell, "created the special hospital which furnished the 
chief experience of this volume." The work was chiefly 
based on the author's own observation. The British and 
Foreign Medico- Chirurgical Revieiv, in a notice of this 
treatise, says it is "the first complete treatise on the subject 
the English language has been in possession of," and adds, 
the volume is "written not only up to the present time, but 
in many respects far in advance of it," to be referred to now 
and in the future " with the utmost confidence and satisfac- 
tion." In 1874 Dr. Mitchell published a paper on post- 
paralytic chorea,' in which he pointed out the fact that 
organic palsies, especially hemiplegia, "are occasionally 
followed by hemichorea, or a still more limited local develop- 
ment of that disorder." In other words, his paper shows 

' American Journal cf tlie Medical Sciences, vol. Ixviii. p. 342, 
Oct. 1874. 



56 PRACTICAL MEDICINE, 

that "as there is a post choreal paralysis, so, also, is there 
a post-paralytic chorea." Our space forbids our pointing 
out the amount of original matter and suggestions which 
these various books and papers contain. As a whole they 
form the most valuable contributions to neurology and 
medicine in general which this country has produced. They 
are admirable as to style, logic, and ideas, and are full of 
suggestive hints and generalizations. 

Any account of American contributions to neurological 
science and therapeutics, would be incomplete without a 
reference to the labours of T>i\ William A; Hammond in 
that direction. His investigations upon the physiological 
action of remedies will be referred to in another place. 

In his treatise on sleep^ he has added materially to our 
knowledge of the physiology of that mysterious condition, 
and to the therapeutics of insomnia. So far as priority of 
discovery is concerned, the credit of ascertaining that sleep 
is due to a partial anaemia of tlie brain belongs to Drs. 
Durham and Fleming. Dr. Hammond, before he had heard 
of Durham's experiments, made similar ones, and arrived at 
similar results. His treatise, however, not only gives an 
account of his own original experiments upon the state of 
the intra-cranial circulation during sleep, but presents the 
whole subject of sleep and its derangements in a clear and 
satisfactory manner. 

A full account of Dr. Hammond's contributions to neuro- 
logical science may be found in his recent work on Diseases 
of the Nervous System. Of this treatise the author says in 
his preface : " One feature I may, however, with justice claim 
for this work, and that is that it rests to a great extent on 
my own observation and experience, and is therefore no mere 
compilation. The reader will readily perceive that I have 
views of my own on every disease considered, and that I have 

• Sleep and its Derangements, by Williaui A. Hammond, M.D. 



PRACTICAL MEDICINE. 6t 

not hesitated to express them." The size of the work for- 
bids our attempting to analyze it here. For any accurate 
notion of Dr. Hammond's peculiar views, and original ob- 
servations, w^e must refer those interested in the matter to 
the work itself. We desire, however, to call attention to the 
account which it gives of athetosis, a disease first recognized 
and, we believe, first described by Dr. Hammond. His 
description of this rare afifection is illustrated by two cases 
of it, which have come to his knowledge. 

Electro-physiology, and electro-therapeutics for the last 
twenty-five years, and especially since the appearance of the 
treatise of Duchenne of Boulogne, upon those subjects, have 
attracted a great deal of attention. American as well as 
European observers have been busy with efforts to discover 
the relations of electricity to the nervous system. By far 
the most important contribution made by any American 
observer to this sui^ject, is the treatise^ of Dr. Charles E. 
Morgan. Unfortunately the author died before the work 
went to press. It was published under the editorial care of 
Dr. William A. Hammond, who thereby bore unequivocal 
testimony to its value. We learn, moreover, that so high 
an authority as Professor Rosenthal would gladly have 
undertaken the revision and editorship of this work, not 
only as a proof of his esteem for its writer, but also from 
his conviction of its eminent scientific value. An obscurity 
of style due partly to a lack of personal revision, and partly 
to German methods of expression, which the author's long 
residence and study in Germany had led him into, pervade 
the book. Whoever masters his style and gets at his thought 
will agree with the editor "that there is nothing in the 
English language which at all approaches it as regards the 
scientific treatment of the whole subject of electricity." It 

' Electro-physiology and Therapeutics, Charles E. Morgan, A. B., 
M.D., New York, 1868, pp. 714. 



58 PRACTICAL MEDICINE. 

is mainly physiolo^^ica], only about twenty-five pages being 
devoted to the therapeutics of the subject. The character 
of the results at which he arrived, and the stamp of his 
mind, may be derived from the closing paragraph of the 
book. " Such are the definite scientific applications of 
electricity to medical purposes; of the many others it need 
only be said that they are either based on incorrect theory 
or diagnosis of disease, or an imperfect or incorrect knowl- 
edge of electro-physiology ; although I do not deny that 
future researches may enable us to do more, far more than 
has hitherto been done in this direction." 

The New York Society of Neurology and Electrology 
recently appointed a committee consisting of Prof. John C. 
Dalton, Dr. George N. Beard, and three others to examine 
and report upon the existence and localization of motor 
centres in the cerebral convolutions. The committee made 
a number of carefully conducted and ingenious experiments 
upon dogs.^ The results at which the committee arrived 
confirmed the most important of those obtained by Hitzig 
and others who have followed him in this line of experiment. 
Although these and similar investigations are purely phy- 
siological in their character, yet they have such an obvious 
bearing upon diseases and treatment of the nervous system 
that they really belong to practical medicine. 

The drugs of the Materia Medica, which are fortunately 
no longer regarded as the only or chief agents by which dis- 
ease is prevented or combated, still justly hold an important 
though secondary place in the armamenta medicorum. The 
contributions of America to this department of practical 
medicine during the past century have been numerous and 
valuable. Our space permits a reference to only a few of 
them. As South America does not come within the limits 
of our survey, we are prevented from referring to cinchona 

I New York Medical .Journal, March, 1875. 



PRACTICAL MEDICINE, 59 

and its alkaloids, a contribution to tlie resources of raedical 
art, American in its origin, without which the modern prac- 
tice of medicine would be sadly crippled. Excluding this 
and all other South American medicinal products from our 
consideration, let us glance at what the United States has 
contributed in the past century. As we shall have occasion 
to see by and by, it has led the way in the introduction of 
one class of agents whose value cannot be over-estimated. 

Contributions to materia raedica are of two classes. The 
first class comprises new, or previously unknown agents, 
whether vegetable or mineral in their origin, as veratrum 
viride or wild cherry, and also new chemical combinations, 
as chloroform or chloral. The second class comprises re- 
searches, either clinical or physiological, into the action of 
medicines, by which their therapeutical power and limits are 
determined. This class of course includes experiments by 
vivisections or otherwise on animals and various sorts of 
chemical analyses. 

Let us glance for a moment at the first of these classes. 
For two or three hundred years previous to the beginning 
of the present century, there was a popular notion floating 
about in the community, especially in Germany and parts 
of France, to which physicians gave very little credence, 
that ergot was an oxytocic. It was commonly known in 
Germany by the name of mutterkorn, and in this country, 
as well as in Europe, was sometimes called pulvis parturi- 
faciens, names that indicate the popular notion of its power. 
Notwithstanding the efforts of a distinguished French ac- 
coucheur, Desgranges, who recognized its value more than 
a century ago, and endeavoured to bring it into use, it was 
forgotten or not accepted by the faculty. Dr. John Stearns, 
of Saratoga County, New York, in a memoir^ published in 
1808, again called attention to ergot as a remedy for qnick- 

» New York Medical Repositorj, 1808, vol. xi. p. 303. 



60 PRACTICAL MEDICINE 

ening childbirth. The paper gives an admirable account of 
the article it describes, and the profession since its time have 
acquired very little additional information with regard to 
it, for Dr. Stearns not only recognized its action upon the 
uterus, but its constringing power over the small blood- 
vessels, through the intervention of the nervous system. 
Soon after the appearance of Dr. Stearns' paper other 
observers confirmed his statements. Dr. Oliver Prescot 
published in 1814 a paper,^ giving an account of the natural 
history and medical effects of secale cornutura. This paper 
though a less valuable contribution to medical science, than 
that of Dr. Stearns, had merit enough to be honoured by a 
French translation, and an introduction into the Dictionnaire 
des Sciences Medicales. The medical profession were now 
fully aroused to the value of ergot. The use of it spread 
rapidly over this country, and it was not long before Euro- 
pean physicians recognized its virtue. It was established in 
the place it now holds as one of the important articles of the 
materia medica. American medical science may fairly claim 
the merit of restoring to therapeutics an agent, whose virtues 
Europe had failed to -recognize. 

We have the authority of the United States Dispensatory 
for the statement, that "chloroform was discovered by Mr. 
Samuel Guthrie, of Sackett's Harbour, N. Y., in 1831. 
At about the same time it was also discovered by Soubeiran 
in Fra!ice, and Liebig in Germany." Though the priority 
of discovery belongs to the American chemist, yet it is 
evident that the discovery was made by each of the three 
observers independently of each other ; it is also evident 
that none of them had any notion of the anaesthetic virtue 
of chloroform to which we shall refer further on. In con- 

• A Dissertation on the Natural History and Medical Effects of 
Secale Cornutnm or Ergot, by Oliver Prescot, Medical and Physical 
Journal, 1814, vol. xxxii. p. 90. 



PRACTICAL MEDICINE. 61 

nection with the importance that chloroform afterwards at- 
tained, it is interesting to recall the language which Mr. 
Daniel B. Smith, of Philadelphia, used with regard to it in 
1832. "The action of this ether" (meaning chloroform) "on 
the living system is interesting, and may hereafter render it 
an object of importance in commerce. Its flavor is delicious, 
and its intoxicating qualities equal to or surpassing those 
of alcohol. It is a strong diffusible stimulus, similar to the 
hydrated ether, but more grateful to the taste. "^ 

Dr. Stille, in his Theraj^eutics and Materia Medica, makes 
the statement that the American Indians were acquainted 
with some of the virtues of podophyllum. At any rate it 
was for a long time popularly known and used as a cathartic 
in this country before physicians employed it. Dr. Jacob 
Bigelow accurately described both the plant and its medicinal 
properties more than forty years ago. It did not come into 
general use, however, until its active principle, known as 
podophyllin, or more exactly resina podophylli, had been 
extracted. It is now freely used both in this country and in 
Europe, and cholagogue as well as cathartic properties are 
attributed to it. Although its virtues have been exag- 
gerated, as have those of leptandrin and gelsemium, yet all 
of them are valuable additions to the materia raedica. 

The wild cherry, or prunus virginiana, is another contri- 
bution from the flora of America that deserves honourable 
mention. Its tonic and sedative properties were recognized 
more than fifty years ago by Dr. John Eberle, whose Thera- 
peutics and Maleria Medica introduced to the acquaintance 
of physicians a number of articles, previously unknown or 
little known, derived from the American! vegetable king- 
dom. Dr. Eberle's experiments made upon himself with an 
infusion of wild cherry, by which he demonstrated its sedative 
influence upon the heart, deserve to be remembered not only 

' Journal of the Pliila. Coll. of Pharmacy, iv. p. 118. 
6 



62 PRACTICAL MEDICINE. 

on account of their intrinsic value, but because they show a 
recognition by him, at that early period, of the importance 
of making the physiological action of drugs the guide to 
their therapeutical employment. Dr. George B. Wood, of 
Philadelphia, one of the most accomplished of American 
physicians, has pointed out in his Therapeutics and Materia 
Medica the value of wild cherry in phthisis. Some of the 
foreign journals have also recorded observations in confirma- 
tion of these statements. 

In 1850, Dr. W. C. Norwood, of South Carolina, pro- 
claimed^ in somewhat extravagant language the sedative 
virtues of veratrum viride. Dr. Tully, of New Haven, and 
other American physicians had previously employed it, but 
the attention of the profession was not generally directed to 
it until Dr. Norwood so ardently advocated its employment. 
Since that time, its active principles, viridia and veratroidia, 
have been isolated, and they, and the plant from which they 
are derived, have been subjected to a careful examination, 
so as to ascertain their physiological action. European 
and American physicians and chemists have interested 
themselves in this inquiry. The experiments''^ of Dr. H. C. 
Wood, Jr., of Philadelphia, are among the most valuable 
that have been made, and are satisfactory and conclusive. 
While they do not sustain the extravagant claims of Dr. 
Norwood, they demonstrate that veratrum viride deserves a 
place in the materia medica. 

As we have already intimated, we cannot undertake to give 
an accurate catalogue of the numerous articles that have 
been introduced into the materia medica from the American 
vegetable kingdom. We can barely refer to such articles 
as geranium maculatum, whose astringent virtues have a 

1 Southern Med. and Surg. Journal, .June, 1850. 

2 Amer. Journ. Med. Sci., 1870, and Philadelphia Medical Times, 
vols. ii. and iii. 



PRACTICAL MEDICINE. 63 

local reputation ; sanguiuaria canadensis, which posseses 
emetic and expectorant properties; spigelia marilandica, 
whose anthelmintic virtues were described a century ago by 
Drs. Garden and Clialmers, of South Carolina; apocynum 
cannabinura, an emetic and cathartic, whose vulgar name of 
Indian hemp has led some practitioners to mistake it for a 
very different article, the Indian hemp of India ; senega or 
seneka root (introduced by Dr. Tennant, of Virginia, in 
1731), whose valuable expectorant properties are recognized 
in Europe and in this country ; serpentaria or Virginia 
snakeroot, used by the American aborigines as a remedy for 
snake-bites, and considered by physicians of the present day 
to have stimulant, tonic, and other properties; enpatoriura 
perforatum, wiiich, under the less learned name of thorough- 
wort, is largely used in domestic practice; lobelia or Indian 
tobacco, an agent of undoubted activity as an emetic, a seda- 
tive, and an expectorant, largely used by a notorious char- 
latan and his disciples, and which possesses a value that gives 
it a place in our modern materia medica ; gillenia, whose 
virtues as an emetic would enable it to replace ipecacuanha, 
if the latter could not be easily obtained ; sassafras, sabbatia, 
gaultheria, and a variety of other plants. These, and other 
articles that might be mentioned, are additions of greater 
or less importance to the practitioner's list of remedies. 
Some of them are only known locally; others have travelled 
beyond the sea, and enjoy a transatlantic reputation. They 
are mentioned not only on account of their intrinsic merits, 
but to show that American physicians have not neglected 
to explore their native forests and fields, with the hope of 
enriching the materia medica of the world. 

Our account of American contributions to materia medica 
would be imperfect without a reference to the works of Dr. 
Jacob Bigelow on medical botany. In 1814 he published 
an octavo volume upon the plants of Boston and its environs. 
A few years later, he published his American Medical Botany 



64 PRACTICAL MEDICINE. 

in three volumes, illustrated. This was a contribution to 
medical science of the highest order. Its descriptions are 
accurate, concise, and complete. The fifty years that have 
elapsed since its appearance have taken very little from, and 
added very little to his account of the plants he described 
or of their medicinal virtues. It still maintains its place as 
an authority upon the subjects of which it treats. In this 
connection the Medical Botany of Dr. W. P. C. Barton 
should be mentioned. It covers a different ground from 
that of Dr. Bigelow, but like his is a valuable addition to 
medical science. 

Let us now pass to the second class of contributions to 
materia medica, viz., clinical, or physiological researches 
into the action of medicines upon the human system. 
American physicians and physiologists have begun to culti- 
vate this delicate, difficult, and important field of inquiry. 
Prominent among the explorers of this region is Dr. William 
A. Hammond, of New York. His researches^ upon the 
physiological effects of alcohol and tobacco upon the human 
system, upon albumen, starch, and gum, upon the excretion 
of phosphoric acid, and upon certain vegetable diuretics 
have added to our knowledge of these articles. Many of 
the experiments upon which these papers are founded were 
made upon himself. His paper upon alcohol appeared 
nearly fifteen years ago. It was limited chiefly to the action 
of alcohol upon metamorphosis of tissue. Since its appear- 
ance, the well-known, laborious, and entensive researches, 
in the same direction, by Lallemand, Perrin and Duroy, 
Anstie, Parkes, Binz, Duchek, and others, have greatly 
increased our knowledge of the physiological action of 
alcohol, but have not substantially shaken the conclusions of 
Dr. Hammond. The diuretics whose action he investigated 
were squill, juniper, digitalis, and colchicum. His object 

1 Physiological Memoirs by William A. Hammond, M.D. 



PRACTICAL MEDICINE. 05 

was to ascertain their influence over the quantity of the 
urine, its specific gravity, and the amount of its solid organic 
and inorganic constituents. His results explain and confirm 
the conclusions with regard to the therapeutical value of 
these drugs that physicians have generally held. 

Tile experiments of Dr. Hammond as to the physiological 
action of diuretics upon healthy adults, were supplemented 
by a series of clinical experiments^ with diuretics by Dr. 
Austin Flint, of New York. Dr. Flint experimented with 
squill, digitalis, nitrate of potassium, iodide of potassium, 
acetate of potassium, colchicum, and juniper. He gave thesb 
articles separately and in combination. His conclusions with 
regard to their action upon the solid and liquid constituents 
of the urine, substantially confirm those of Dr. Hammond. 
Dr. Flint modestly calls these researches "a small contribu- 
tion to the study of the effects of diuretic remedies ;" they 
are not only valuable in themselves, but at the time they were 
made, fifteen years ago, had an especial value as indicating 
the proper method of the clinical observation of remedies. 

The researches of Dr. H. C. Wood, Jr., upon the physio- 
logical action of drugs are admirable illustrations of the 
modern method of ascertaining their action. We have 
already referred to his study of the action of veratrum viride 
and its alkaloids. He has made several other similar con- 
tributions, which are embodied in his recent work, Thera- 
pe^itics, Materia Medica, and Toxicolorjy. This work is an 
original contribution to practical medicine. It not only 
presents a condensed statement of the author's investiga- 
tions, but of the best European investigations upon the 
physiological action of medicines. 

In this connection, it should be mentioned, that the recent 
experiments of Dr. Robert Amory, of Boston, and of Prof. 
H. P. Bowditch, of the same city, upon the absorption and 

• American Me'l. Monthly, New York, Oct. 18G0. 



G6 PRACTICAL MEDICINE. 

elimination of the bromide of potassium and its kindred 
salts, have enlarged our knowledge of the action of those 
remedies in this direction. Dr. J. H. Bill, U. S. A., made 
a series of experimental researches into the action and thera- 
peutic value of the same article, which he published^ in 1868. 
The experiments were made on man. They w^ere carefully 
conducted, and led him to the conclusion that "bromide of 
potassium, in its legitimate action, is an anassthetic to the 
nerves of the mucous membranes and a depressor of their 
action." 

Dr. S. Weir Mitchell, assisted by Drs. Keen and More- 
house, made some admirable observations and experiments,^ 
at the United States Army Hospital for injuries and diseases 
of the nervous system, upon the antagonism of atropia and 
morphia. They also made an examination into the power 
of conia, daturia, atropia, and morphia to destroy neuralgic 
pain. Their observations led them to the conclusion that 
morphia and atropia act as mutual antagonists in certain 
of their effects. The paper is marked by the care, accuracy, 
and completeness that characterize all of Dr. Mitchell's 
researches. It deserves to be read in connection with Dr. 
Eraser's exhaustive researches in the same direction. 

An American, travelling in Hungary not long ago, at- 
teqded some sort of a public meeting in one of the large 
towns of that region. One of the speakers had occasion to 
allude, in the course of his remarks, to Boston in the United 
States. He referred to it as a place well known to the 
audience, and distinguished not as the cradle of the American 
revolution, not for its commerce, not for its literature, not for 
its statesmen, its authors, its poets, and its theologians, not 
for its manufactures, not for its common school system, but 
as the place where anaesthesia by means of sulphuric ether 

J Amer. Jouna. Med. Sciences, July, 1868. 
2 Ibid., July, 1865. 



PRACTICAL MEDICINE. 67 

was discovered. This discovery has rendered the name of 
Boston familiar to the dwellers on tlie Danube and the 
Caspian. Such a fact may not be gratifying to the vanity 
of Bostonians, bnt it testifies to the universal recognition 
of the inestimable value of artificial anaesthesia. In every 
part of the civilized world, and wherever, in those regions 
called uncivilized, the pioneers of civilization have pene- 
trated, in Japan, in China, in the islands of the sea, the 
power to produce anaesthesia, which ether first revealed, is 
acknowledged and blessed. The knowledge of it is so 
universal, and the blessings which attended its use ar^ so 
constant, that we are sometimes apt to think as little of its 
existence and power as we do of the presence and power of 
light. It is impossible to estimate or form any adequate 
conception of the amount of human suffering which anass- 
thetics have relieved and prevented. To their discovery 
the human race owes the blessing that no pain follows the 
course of the surgeon's knife into any living tissue; that 
the accoucheur can, when necessary, alleviate or abolish the 
agonies of travail ; that sleep can be procured in spite of 
any agony ; and that at the word of the physician any 
sufferer may be rendered unconscious of torture. Such a 
power, which John Baptista Porta had strangely prophesied 
centuries ago, which mesmerism hinted at, which mystics 
have now and then proclaimed, but which the world never 
dared to expect, was shown to exist and to be capable of 
safe and easy application by the use of sulphuric ether at 
the Massachusetts General Hospital in 1846 It was, per- 
haps, the greatest contribution to practical medicine that 
the world has ever received. Of itself, it is enough to 
render American medical science honoured and memorable. 
As soon as it was generally known that the inhalation of 
the vapour of sulphuric ether would produce insensibility, 
experiments were made with various substances by physicians 
in this country and in Europe, who hoped to discover other 



C8 PRACTICAL MEDICINE. 

agents, the inhalation of whose vapour would produce anaes- 
thesia as well as ether, or, perhaps, better than that article. 
The most distinguished of these experimenters. Sir James 
Y. Simpson, of Edinburgh, tried cliloroform, a substance 
which was previously regarded chiefly as a chemical curiosity. 
The experiment of Sir James, made upon himself, disclosed 
the fact that chloroform was an anaesthetic of great power. 
The inhalation of its vapour acted rather more rapidly than 
the inhalation of ether, was less disagreeable to the patient, 
and in a very small quantity produced profound angesthesia. 
The knowledge of the discovery of this new anaesthetic 
spread rapidly over Europe and this country. The ease 
of its application, the profound insensibility which it pro- 
duced, its freedom from any unpleasant odour, and the fact 
that it was discovered in Europe, while ether came from 
ihe wilds of America, and other circumstances, led to its 
adoption almost universally throughout Europe as an anes- 
thetic in preference to ether. It was also used very largely 
in this country, but not as exclusively as on the other side 
of the Atlantic. The experience of a quarter of a century 
has shown that the inhalation of chloroform is fatal in a 
certain proportion of cases, while the inhalation of ether is 
comparatively innocuous. 

American medical science has not only contributed to 
practical medicine the discovery of artificial anaesthesia, but 
insists that the anaesthetic, which it first presented to the 
world, is still the best that is known to science ; it insists 
upon its demonstration of the fact that pure concentrated 
sulphuric ether is preferable, as an anaesthetic, to chloro- 
form ; and, as a logical conclusion from this, it insists that 
the persistent use of chloroform by European physicians is 
a grave and serious error. This is not the place, even if 
we had the time, to discuss the comparative merits of ether 
and chloroform. Physiological experiments and clinical 
experience are both in favour of ether, and against chloro- 



PRACTICAL MEDICINE. 69 

form. The prolonged inhalation of ether by man affects, 
first, the cerebrum ; second, the sensory centres of the cord ; 
third, the motor centres of the cord; fourth, the sensory; 
and fifth, the motor centres of the medulla oblongata. When 
ether kills, it does so by producing asphyxia, leaving the 
pulsations of the heart to warn the surgeon of the approach 
of danger — warnings which only the most reckless careless- 
ness can fail to notice. Chloroform, like ether, affects chiefly 
the brain and spinal centres; but its action upon the sensory 
and motor centres is more rapid than that of ether. Upon 
the heart it produces a steadily depressing influence. When 
it kills, it does so by cardiac paralysis, acting directly upon 
the heart-muscle, and not by asphyxia; consequently there 
is no warning of impending death, and the greatest careful- 
ness cannot avert the fatal issue. When ether kills, death 
is due to the carelessness of the operator; when chloroform 
kills, death is due to the rashness, wilfulness, or ignorance 
of the operator in the selection of his anaesthetic. Dr. H. 
C. Wood, Jr., whose contributions have been previously 
referred to, says : — 

" As an anaesthetic, chloroform possesses the advantages of 
quickness and pleasantness of operation, smallness of dose, and 
cheapness. These advantages are, however, so outbalanced by 
the dangers which attend its use, that its employment under 
ordinary circumstances is unjustifiable. It kills without warn- 
ing, so suddenly that no forethought, or skill, or care can guard 
against the fatal result. It kills the robust, the weak, the well, 
the diseased, alike ; and the previous safe passage through one 
or more inhalations is no guarantee against its lethal action. 
Statistics seem to indicate a mortality of about one in three 
thousand inhalations; and hundreds of utterly unnecessary 
deaths have now been produced by the extraordinary persist- 
ence in its use by a portion of the profession. It ought, there- 
fore, never to be employed except under special circumstances, 
as in some cases of puerperal eclampsia, when a speedy action 



70 PRACTICAL MEDICINE. 

is desired, or in the field during war time, where the bulkier 
ancesthetics cannot be transported."' 

These png-es have made no reference to the contributions 
which American medical science has made during the past 
century to surgery, to obstetrics, including gynaecology, or 
to medical literature. An account of these contributions, 
and of the work of American physiologists, will be presented 
in future essays. The limited portion of the field, however, 
which we have surveyed has yielded enough of interest and 
importance to justify an honest pride on the part of Ameri- 
can physicians in the work they have accomplished, and to 
give assurance of continued and zealous labour in the future. 

The blank pages of the book, containing all the secrets 
of medicine, which Boerhaave bequeathed to the future, 
were prophetic of the work which medical science was des- 
tined to accomplish. The science of his age could inscribe 
only a single sentence upon a single page. The present 
century, whose closing hours the nation celebrates, has filled 
two or three additional pages with the secrets it has dis- 
covered, calling them vaccination, anaesthesia, and preven- 
tive medicine. It now transmits the volume to the coming 
ages, confident that each succeeding century will make new 
discoveries, till all of Xature's secrets are discovered, and 
then the title of the book shall be the just index of its con- 
tents. 



The discovery of artificial anaesthesia was an event of such 
transcendent importance that it becomes necessary to give 
a complete account of it in this connection. As soon as its 
value was established a number of individuals claimed the 
honour of its discovery. The controversy which the various 

1 Treatise on Therapeutics, etc., by H. C. Wood, Jr.. M.D., p. 
251. 



PRACTICAL MEDICINE. 71 

claimants and their partisans have carried on has been pro- 
longed and sometimes bitter. Most of those who were fami- 
liar with the way in which the discovery w^as introduced to 
the public and acquainted with the claimants to it, and in 
a position to form an impartial and correct opinion of the 
value of their claims, are no longer living. Of the sur- 
geons of the Massachusetts General Hospital, who were 
present when the first operation under ether, the experi- 
mentum crucis of the new discovery, was performed, only 
one is now living. Fortunately that one, Dr. Henry J. Bige- 
low, the distinguished and accomplished professor of surgery 
in Harvard University, was not only present when the first 
operation was performed, but was personally acquainted with 
most of the steps in the early progress of the discovery, with 
the claimants to the honour of it, and with all of importance 
that appertains to the history of it. He did more than any 
other living person to bring it before the medical public of 
this country and of Europe, to assert its real value, and to 
point out the best methods of utilizing it, A quarter of a 
century has elapsed since its discovery. This period is long 
enough for the heat of partisanship to cool, and to afford 
an opportunity for an impartial statement, by an impartial 
observer, to be heard with calmness and interest. More- 
over, the centennial anniversary of the nation's existence is 
an auspicious moment for putting on record the testimony 
of an intelligent and disinterested witness to the discovery 
of an agent in which the whole human race are interested. 
With the hope of obtaining from Dr. Bigelow a history of 
the discovery of anaesthesia, the following note was ad- 
dressed to him : — 

"Dr. Hexry J. BiGRLOW, Professor of Surgery in Harvard Dni- 

vtrsity. 

Dear Sir : I am preparing a report on the progress of prac- 
tical medicine in this country for the past century. In such an 
essay a notice of America's greatest contribution to medicine, 



72 PRACTICAL MEDICINE. 

modern ansBsthesia, is indispensable. If you have the time and 
are willing to prepare a history of its discovery, with which you 
are so familiar, you will not only confer a favour upon all inte- 
rested in it, but will put on record an authentic account of the 
discovery, by one who was an eye witness and actor in its early 
scenes, and to whose statements, on account of their disinte- 
restedness, great value is attached." 

To this letter the following paper was received in reply. 



A HISTORY 



DISCOVERY OF MODERN AMSTHESIA. 



BY 

HENRY J. BIGELOW, M.D., 

PROFESSOR OF SURGERT IN HARVARD UXIVERSITY, 



A HISTORY 



DISCOVERY OF MODERN ANiESTHESIA. 



My Dear Sir: A quarter of a century ago, your simple 
proposition would have re-awakened a discussion which had 
already exhausted the subject. Even so long ago as 1848, 
I thought it discreet to preface a paper upon the abstract 
question of discovery, as decided by historical precedent, 
with the disavowal of an intention to " dig up the well-worn 
hatchet of the ether controversy." But I see no objection 
to a review now — final, so far as I am concerned — of the 
occurrences you refer to, especially if I offer no opinion 
without its reason. 

The singular persistence of the controversy was due to a 
variety of causes. People differ in their views about what 
constitutes a discovery or a discoverer. A voluminous mass 
of sworn testimony availed little in those days, for want of 
some machinery to reach and fix a decision based upon it. 
One of the contestants, at least, felt this, and vainly urged 
a court of justice.^ Preponderating opinions and evidence 
were laboriously and repeatedly brought to the surface by 
Congressional committees, and by other bodies and com- 
mittees of those most familiar with the circumstances; but, 
for the lack of a tribunal accustomed to estimate the weight 

' See Congressional Debates for the sessions of 1853 and 1854. 



16 DISCOVERY OF ANAESTHESIA. 

and quality of scientific evidence, not to say evidence of 
fact, no absolute decision was reached. The result was, that 
every new discussion began and ended like the preceding, 
and to as little purpose. 

When the discovery was announced (October, 1846), the 
circumstances were few and recent, and the details of its 
progress were known. But when history was obscured, 
when another State, and even another Nation, had set up 
each its own discoverer, and readers were perplexed with 
volumes of new reports and new testimony, it became less 
easy to sift the evidence. Claims, till then distinct, overlaid 
each other. Each alleged inventor, with his partisans, aimed 
to secure the whole honour. Opinions were pronounced 
by people who knew little of the facts. Attempts were even 
made, in more than one instance, to forestall or manufacture 
public opinion, by procuring in promiscuous medical as- 
semblies and legislatures sudden votes designating some 
discoverer by name, with a view to influence the erection of 
statues. In a scientific view such votes are not worth the 
paper that records them; but it cannot be doubted that in 
a free country every citizen has the inherent right, of which 
the late Lord Timothy Dexter so liberally availed himself, 
to erect in his front yard a statue with an inscription. 

The claimants to the discovery are three — Dr. Wells, 
Dr. Jackson, and Dr. Morton. In discussing their claims, 
we cannot overlook the fact that the discovery was equally 
possible to either of them, or indeed to any moderately 
ingenious person whose attention should have been directed 
to the subject. This greatest single step forward in the 
history of medicine, like the division of the Roman printing- 
block, was a very small advance in strictly scientific knowl- 
edge. Facts of insensibility to pain, produced both by gas 
and ether, were already known to the world. Art needed 
only an extension of their application; and so far as art or 



DISCOVERY OF ANiEST IIESI A. 7Y 

science was involved, either Wells, Jackson, or jNiforton was 
conipetent to the work. 

This simple statement comprehends certain points of vital 
importance. The first essential requisite of modern anoBsthe- 
sia is, that it shall be always attainable, and, when attained, 
complete. A second requisite is, that the insensibility 
shall be safe. The discovery embraced the threefold and 
essential novelties, that it is, under proper guidance, com- 
plete, inevitable, and safe, and not, like all previous stupe- 
faction, partial, occasional, or dangerous. If only partial or 
occasional, or if dangerous, neither the patient, tlie dentist, 
nor the surgeon would consider it of value. Even so late 
as a year after the discovery, many surgeons, and, extra- 
ordinary as it may now appear, some hospitals, absolutely 
declined to use the new means of producing insensibility, on 
the ground that it was attended with danger. 

Readers of the present day may not remember how sur- 
prisingly far previous knowledge of anaesthesia had extended. 
Although there has been a want of discernment in attempts 
to point out precisely what the new advance upon previous 
knowledge was, one great difficulty has been, that this 
advance was so small, in a strictly scientific view, that it 
was not easy to measure it. This difficulty was enhanced 
by the magnitude of the spoil, whether mere honour, or, as 
beyond all question it should have been, emolument. 

A rapid review of the history of early anaesthesia will bring 
us to the period with which we are especially concerned. 

In the anaesthetic state, the action upon the brain may be 
a primary one, as by its compression, or by hypnotism — or 
secondary, as by narcotic and inebriating agents absorbed 
into the blood, from the lungs, the digestive tube, the skin, 
or other tissues. A few extracts, abridged from the familiar 
literature of the subject, will show that surgical anaesthesia in 
these various forms has been long known and longer sought. 

The use of poppy, henbane, mandragoru, hemp, etc., to 
7* 



78 DISCOVERY OF ANESTHESIA. 

deaden the pain of execution and of surgery, may be traced 
to a remote antiquity. Herodotus ascribes to the Scythians 
the use of a vapour of hempseed to produce drunkenness by 
inhalation. In China, Hoa-tho, in the year 220, administered 
hashish {Mayo) and performed wholly painless amputations; 
the patient recovering after a number of days. Hashish, 
described by Herodotus twenty-three centuries ago, is the 
active agent of the modern Bhang of India. 

Pliny, who perished A.D. 79, says of mandragora: "It is 
drunk before cuttings and puncturings, lest they should be 
felt." Dioscorides gives an elaborate method of preparing 
mandragora to produce anaesthesia (rtoistv avaiod 'fiaiav) in 
those who are to be cut or cauterized — " or sawed," adds 
Dodoneus, and who in consequence "do not feel pain." Half 
an ounce, with wine, says Apuleius, a century later, enables 
a patient to sleep during amputation "without sensation." 
"Eruca" was used by criminals about to undergo the lash. 
" Memphitis," a "stone," so " paralyzed parts to be cut or 
cauterized that they felt no pain." 

Theodoric, about the year 1298, gives elaborate directions 
how to prepare a '' spongia somnifei^a,'''' by boiling it dry in 
numerous strong narcotics, and afterwards moistening it for 
inhalation before operations. In 1832, M. Dauriol, near 
Toulouse, cites five cases of insensibility during surgical 
operations, induced by him with the aid of a similar 
"sponge " It is said that persons unpacking opium have 
fallen suddenly. 

In 1532, Canappe described the inhaling-sponge of Theo- 
doric, and at the same time warned surgeons against giving 
opium (a 6oiVe), which "sometimes kills." But in later 
years, and until ether was introduced, it was the rule to 
give opium before operations. 

September 3, 1828, M. Girardin read to the Academy 
of Medicine a letter addressed to his Majesty, Cliarles X., 
describing surgical anaesthesia by means of inhaled gases. 



DISCOVERY OF ANESTHESIA. 79 

Richeraiifl sugrgests drunkenness in reducing dislocations. 
Patients, while dead drunk, have been operated upon pain- 
lessly, and a dislocated hip was thus reduced after a bottle 
of Port wine. Haller, Deneux, and Blandin report like 
painless results in surgical and obstetric experi.ence. 

Baron Larrey, after the battle of Eylau, found in the 
wounded who suffered amputations a remarkable insensi- 
bility, owing to the intense cold. Of late years congelation 
has become a recognized agent of local ansesthesia. 

Hypnotism is a very remarkable cerebral condition, by 
which surgery has been rendered painless. It is the grain 
of truth upon which the fallacies of mesmerism, animal 
magnetism, and the rank imposture of so-called spiritualism 
have been based. 

The experiments of the Grotto del Cane are familiar, as 
also are recoveries from accidental asphyxia after complete 
insensibility. 

About a year ago, two healthy men, at my request, inhaled 
atmospheric air from a common gas-bag. As carbonic acid 
replaced the oxygen, they both became livid, and, to every 
external sign, utterly insensible. One was really insensible; 
the other nearly so, but, being a plethoric subject, it was 
deemed prudent in his case not to press the inhalation 
further. 

Nitrous oxide after a time asphyxiates, owing to the 
chemical combination of its gases — on that account parting 
reluctantly with its oxygen. But it also exhilarates, and 
its angesthesia is probably something more than a condition 
of asphyxia. 

These facts show that from time immemorial the world 
has been in possession of an anaesthesia which was occa- 
sionally resorted to, and not unfrequently amounted to com- 
plete insensibility. But, as a rule, the following proposi- 
tions held good in respect to it. 

1st. It could not be relied on to affect everybody. 



80 DISCOVERY OF ANESTHESIA. 

2d. It was often insufficient. 

3d It was sometimes dangerous. 

What surgeons and patients needed was an inevitable, 
complete, and safe condition of insensibility; and tliis they 
were soon to have. 

The moment arrived. In three months from October, 1846, 
ether anaesthesia had spread all over the civilized world. 
No single announcement ever created so great and general 
excitement in so short a time. Surgeons, sufferers, scientific 
men, everybody, united in simultaneous demonstration of 
heartfelt mutual congratulation. 

It is to be regretted that no single individual stood out 
clearly, at this time, to receive the homage and gratitude of 
the world. 

Nothing like the new anaesthesia had been known before. 
Whatever has been devised since has been a mere imitation 
and repetition of this — I may almost say, with no single 
substantial advantage over it. Our English friends, with a 
pardonable pride in matters of scientific discovery, not un- 
frequently formulate their convictions thus : "A. had indeed 
shown this, and B. that; but it was reserved for our own C. 
to make the imperishable discovery." It is probable that the 
average Englishman still believes that modern anaesthesia is 
identified with chloroform. But the discovery of a prac- 
ticable, safe, and efficient means of insensibility had been 
made a year before chloroform was thought of, and nothing 
important has been added to it since. Chloroform is at a 
first inhalation of an agreeable odour, more portable and 
less inflammable than ether, qualities which eminently adapt 
it to army use; but it will do nothing that ether does not 
do as well, and is sometimes, though quite rarely, it is true, 
followed by fatal consequences. 

We are now to examine the claims of the three individuals 
mentioned, to the discovery of the new ancesthesia. Let us 
look first at those of Dr. Wells. And as preliminary to the 



DISCOVERY OF ANiESTHESTA. 81 

examination of his claim, let us here revert to an interesting 
point in this history. It is impossible to read the annexed 
statement, familiar though it be, without renewed amazement 
that this great blessing to animal existence was distinctly 
ofifered to scientific men, and as distinctly neglected by them 
for half a century. 

The following are the words of Sir Humphry Davy, at 
the beginning of the present century; half the century had 
nearly elapsed before they were again thought of: — 

"In one instance, when I had headache from indigestion, it 
was immediately removed by the effects of a large dose of gas" 
(nitrous oxyde), .... "though it afterwards returned, but with 
much less violence. In a second instance, a slighter degree of 
headache was wholly removed by two doses of gas. 

"T/«e power of the immediate operation of the gas in removing 
intense physical pain I had a very good opportunity of ascer- 
taining. 

"In cutting one of the nulucky teeth called denies sapientice, I 
experienced an extensive inflammation of the gum, accompanied 
with great pain, which equally destroyed the power of repose and 
of consistent action. On the day when the inflammation was 
most troublesome, I breathed three large doses of nitrous oxyde. 
The pain always diminished after the first three or four inspira- 
tions ; the thrilling came on as usual, and uneasiness was for a 
few minutes swallowed up in pleasure. As the former state of 
mind, however, returned, the state of organ returned with it; and 
] once imagined that the pain was more severe after the experi- 
ment than before " 

Towards the conclusion of his book he adds : — 

"-4s nitrous oxyde, in its extensive operations, appears capa- 
hle of destroying physical pain, it may probably be used luith 
advantage duriyig surgical operations in ivhicli no great effusion 
of blood takes place." 

The great discovery was here clearly pointed out to every 
tyro in medicine and chemistry. There were three experi- 
ments, of a completely original character, and with a new 



82 DISCOVERY OF ANESTHESIA. 

agent, in a direction to vvhicli contemporaneous attention 
was not, as afterwards, leaning. Upon these an original 
hypothesis was methodically constructed and distinctly enun- 
ciated in print. It only remained for somebody to test this 
hypothesis, this guess, and to convert the guess into a cer- 
tainty. But neither dentist nor surgeon responded, and the 
world for nearly fifty years attended exhibitions where people 
danced, laughed, and became unconscious, while hospital 
patients were undergoing amputation, alive to all its agony. 

In 1844 Horace Wells appeared, exactly repeating the 
hypothesis that Davy had printed. Whether he got this idea 
from Davy, or from his friend Cooley, or from his own brain, 
is not to the purpose. Davy had announced it, and the 
scientific world knew it. Did Horace Wells convert into a 
certainty the probability of Davy? He did not. He sig- 
nally failed to do so, and, mortified by his failure, he gave up 
all attempts in that direction. More than two years elapsed, 
and the ether discovery was made and completed. Then, 
and then only, was Wells stimulated to renewed effort. But 
it was too late ; the discovery of a surgical anaesthetic had 
been made. 

These facts deserve a careful examination. Wells had 
experimented in about "fifteen cases," and with varying 
success. This he states distinctly in his first reclamation, 
before his claim had expanded so as to embrace, as it after- 
wards did, the whole anaesthetic discovery. 

He was " so much elated with the discovery" (to use his 
own words) "that he started immediately for Boston," and 
obtained from Dr. Warren permission, as Dr. Morton, 
imitating Wells, subsequently did with ether, to exhibit the 
anaesthetic properties of gas before the medical class. Dr. 
Warren was the principal New England surgeon of that day, 
and it was the obvious thing to do. This experiment, which 
was in tooth-pulling, was an utter failure, and was called, as 
Wells says, "a humbug affair." He was completely dis- 



DISCOVERY OF ANESTHESIA. 83 

couraged ; went home, told his friends that the gas "would 
not operate as he had hoped," and wholly ceased to experi- 
ment, from the date of his failure in Boston, in December, 
1844, until the spring of 1847, after he returned from Paris, 
an interval of more than two years. Wells's want of success 
can now be satisfactorily explained. He had, through 
Colton, in following Davy's instructions, made use of the 
traditional exhilarating-gas-bag, and of Davy's exhilarating 
dose. This volume of gas is inadequate to produce ances- 
thesia with any certainty ; and Wells failed to suggest a 
larger dose. This small omission closed his chances. He 
narrowly missed a great invention. Inventors, by thousands, 
have missed inventions as narrowly. 

Modern dental insensibility by nitrous oxide is unfailing, 
because the volume employed is much larger. It is also 
usual to exhale it into the atmosphere. Horace Wells had 
no hand in this method, of which the first demonstration 
was in a breast excision performed by myself at the Massa- 
chusetts General Hospital, in April, 1848, by means of about 
sixty gallons of gas, as a substitute for ether. 

From all this it will be seen that Wells did not, as has 
been claimed for him, "discover that the inhalation of a 
gaseous substance would always render the body insensible 
to pain during surgical operations,'''' but only that it would 
occasionally do so; and until long after the ether discovery, 
his experiments were not ^'surgical ojoerations,^'' but only 
tooth-pulling. Wells's anesthesia had no value to patient, 
dentist, or surgeon. In endeavouring to trace dental 
anaesthesia, as Davy had directed, from toothache to tooth- 
pulling, his experiments unfortunately and erroneously 
showed that what availed in Davy's hands for toothache 
would not always avail for tooth-pulling. His slight, but 
fatal, error of using an inadequate volume of gas damaged 
the knowledge of his day; so that a scientific person who 
had read Davy's encouraging and unqualified prediction, 



84 DISCOVERY OF ANESTHESIA. 

based upon his three successful experiments, would have 
been discouraged and thrown off the track by witnessing 
Horace Wells's contradictory results. 

Wells returned from Boston to Hartford. Having hoped 
much from anaesthesia as a money speculation, he now left 
it for more promising enterprises. He got up a panorama 
or exhibition of Natural History at the City Hotel at Hart- 
ford ; initiated an extensive business in the sale of patent 
shower-baths; and somewhat largely invested in cheap 
copies of Louvre pictures painted in Paris, to be framed 
and sold by auction in this country. This carried him to 
Paris about December, 1846; an important event in his 
career, as we shall presently see. 

Before he went, however, the ether discovery was made 
(October, 1846), and he received from Morton the following 
letter : — 

"Boston, October 19, 1846. 

"Friend Wells. Dear Sir: I write to inform you that I have 
discovered a preparation, by inhaling which a person is thrown 
into sound sleep. The time required to produce sleep is only a 
few moments, and the time in which persons remain asleep can 
be regulated at pleasure. Whilst in this state the severest 
surgical or dental operations may be performed, the patient not 
experiencing the slightest pain. I have perfected it, and am 
now about sending out agents to dispose of the right to use it. 
I will dispose of a right to an individual to use it in his own 
practice alone, or for a town, count;57, or State. My object in 
writing to you is to know if you would like to visit New York, 
and the other cities, and dispose of rights upon shares. I have 
used the compound in more than one hundred and sixty cases in 
extracting teeth, and I have been invited to administer to 
patients in the Massachusetts General Hospital, and have suc- 
ceeded in every case. 

" The Professors, Warren and ITayward, have given me written 
certificates to this effect. I have administered it at the hospital 
in the presence of the students and physicians, the room for 









/^/T^P-Z^ ^J^Ce.^^ ^ay^e^ 
i^^^-L-^C^ c^^^eJ^^i.^ /^^?2-t^^*-^ <r^-(U>C^ /yC>^<'ru^ ^^^7-.^w /:?^K<-<5<^^^ 






^^TsS. 



DISCOVEllY OF ANESTHESIA. 85 

operations being as full as possible. For further particulars I 
will refer you to extracts from the daily journals of this city, 
which I forward to you, 

" Respectfully yours, 

Wm. T. G. Morton." 

To this Wells returned the following remarkable and 
conclusive reply: — 

" Dr. Morton. Dear Sir : Your letter, dated yesterday, is just 
received, and I hasten to answer it, for fear you will adopt a 
method in disposing of your rights which will defeat your object. 
Before you make any arrangements whatever, I wish to see you. 
I think I will be in Boston the first of next week, probably 
Monday night. If the operation of administering the gas is not 
attended with too much trouble, and will produce the effect you 
state, it luill undoubtedly he a fortune to you, provided it is 
rightly managed. 

''Yours, in haste, 

H. Wells." 

{A facsimile of this letter is here appended. The original 
is in the collection of the 3Iassachusetts Historical Society.) 

Wells would not have thought that Morton's "operation" 
of "administering" his so-called "gas" (meaning ether) 
would prove "a fortune" to him, if his own results of two 
years before had, in the opinion of himself or anybody else, 
any considerable anesthetic value. 

The rest is briefly told. Wells soon after sailed for 
Europe, to prosecute the picture business already men- 
tioned. The distinguished American dentist, Brewster, 
resident in Paris, hearing of his brother dentist Wells, 
sent to him, " begging him to call on him," and asked him, 
"Are you the true man?" "His answers, his manners," 
writes Brewster, "convinced me that he was." "2>r. Wells^s 
visit to Europe,^'' writes Brewster again, ^^ had no connection 
with his discovery, and it was only after I had seen the let- 
ters of Drs. Ellsworth and Marcy that! prevailed upon him 
8 



86 DISCOVERY OF ANAESTHESIA. 

to present his claim to the Academy of Sciences, the Aca- 
demy of Medicine, and to the Parisian Medical Society." 
The quarrel of Jackson and Morton was Wells's opportu- 
nity, and Brewster's persuasion thus secured for him a 
European hearing. 

Thoroughly uneasy, Wells returned home (March, 184t). 
The world was everywhere ringing with ether announce- 
ments. From this period his claim rapidly expanded, 
until it embraced the whole discovery, unsettled his busi- 
ness relations, embittered his life, unhinged his reason, and 
he at last died, in New York, a sudden death, after extra- 
ordinary acts which led even to his arrest, but for which he 
could not be considered responsible. 

Thus perished Wells, volatile, ingenious, enterprising; an 
experimenter, like scores of others, in the field of anaesthesia, 
but, like them, unsuccessful in establishing anything of value. 
So far as his labours went, he left scientific knowledge, as 
well as its application to art, just about where Davy had 
left it half a century before. But he had kept the subject 
alive, and had unintentionally planted a seed in the mind of 
his ambitious partner which yielded fruit. 

We now come to the claims of Dr. Jackson and Dr. Mor- 
ton ; and these, for convenience, we will consider together. 

It is significant that Wells, Jackson, and Morton were 
• all in contact at some period of their anaesthetic experiences, 
of which they shared in some degree a common knowledge. 
Wells, while in Boston, visited Jackson's laboratory; and 
Jackson says that he knew of Wells's experiments; and it 
should be observed that his advice to Channing and Pea- 
body was after Wells's visit. Morton had been Wells's 
partner in dentistry, and boarded at Jackson's house In 
1844 he had been a student of Jackson, who testifies in a 
certificate that he was a "skilful operator in dentistry," and 



DISCOVEaY OP ANESTHESIA. 87 

had "studied the chemical properties of the ingredients 
required for the manufacture of artificial teeth." 

Gas and ether were long familiarly known to produce 
effects so similar that whoever thought of one as an exhi- 
larator or anossthetic must have thought of the other. For 
example while in College, in 1837, I twice made a gaso- 
meter of nitrous oxide, and then substituted for it ether, as 
aflfording equal exhilaration. Brewster, in 1847, said, "It 
required neither a physician nor a surgeon to tell .... that 
ether would produce insensibility, .... as there is scarcely 
a school or community in our country where the boys and 
girls have not inhaled ether, to produce gayety, and many 
are the known eases where they became insensible." In 
short, gas and ether experiences were very similar. Wells 
had been, at the outset, distinctly advised to try ether, but 
elected gas as less dangerous. If, when afterwards "dis- 
heartened by the failure" of his gas experiment in Boston, 
he remembered ether, he doubtless thought it would be 
hardly worth his while to recur to an agent so similar in its 
effects. 

In September, 1846, Jackson and Morton had their well- 
known interview. At this interview Jackson made a sug- 
gestion which was soon followed by a discovery, and by a 
controversy concerning the value of this suggestion. Jack- 
son claimed that the suggestion was the whole discovery. 
Morton took the extreme opposite ground in behalf of his 
experiments. These he alone had conducted, and, while 
Jackson beyond all question kept aloof, he, recognizing 
their generally conceded danger, had gone on with them, 
notwithstanding, and proved what was before only sus- 
pected. 

The interview was briefly this ; and as it is the only 
point at which Jackson touches the progressive line of 
Morton's investigation, it should be stated strongly for 
Jackson. On the 30th of September, 1846, Dr. Morton 



88 DISCOVERY OF ANESTHESIA. 

went to the laboratory of Dr. Jackson, whom lie knew 
well, having been a student under him, and recently in his 
house, and took from a closet an India-rnbber gas-bag. 
In reply to an inquiry of that gentleman, he said, in sub- 
stance (and all that Jackson claims Morton to have said 
may be admitted), "that he meant to fill the bag with air, 
and by its aid extract the teeth of a refractory patient.'" 
A conversation ensued upon the effects of the imagination, 
also, among other things, of nitrous oxide, in producing 
insensibility. Jackson treated Morton's proposition lightly. 
He told him to go to an apothecary and procure sulphuric 
ether — the stronger, the better — which would produce the 
insensibility he desired. The ether was to be spattered on 
a handkerchief and inhaled ; in a moment or two perfect 
insensibility would be produced. " Sulphuric ether," said 
Morton, " what is that ? Is it gas? Show it to me." Jack- 
son showed him some ether, and after further conversation 
Morton went to procure it. Such was the substance of the 
interview at which Morton professed ignorance of ether, 
and Jackson entire knowledge of it. Jackson's knowledge 
and Morton's alleged ignorance we may now consider. 

Dr. Jackson, if we may judge from his later attitude, was 
not indifferent to renown ; nor was he regardless of the suf- 
fering of other people. He claims to have discovered, in 
1842, that ether insensibility was infallible, thorough, and 
safe, and yet he cared so little for his reputation that he 
did not publish his discovery; and he forgot his humanity 
so far, that he allowed patients, the world over, to encounter 
the agonies of amputation during four years more. This 
extraordinary circumstance cannot strengthen belief in the 
fact of the discovery at this early date. 

' It is to be observed here, that, if the patient was intelligent 
enough to obey instructions, and if Morton really meant to admin- 
ister air, the patient would have become insensible by asphyxia. 
(See p. 79.) 



DISCOVERY OF ANESTHESIA. 89 

In a long comraunication to Humboldt, in 1851, and in 
certain other communications to learned foreign societies 
and individuals, Jackson lays great stress upon the elabo- 
rate mental process which enabled him to construct, in 1842, 
an hypothesis of insensibility, based upon the distinct func- 
tions of nerves of motion and sensation, superficial and deep 
sensibility, etc. But the more studied and complete this 
hypothesis, and the more circumstantial the evidence of its 
careful elaboration, the more remarkable is it that it was 
laid on the shelf for four years. Without questioning the 
entire honesty of Dr. Jackson's convictions, it is safe to say 
that it is difficult to measure the original strength of any 
belief which has lain dormant for four years, especially if 
that belief has since proved to be a valuable truth. Dr. 
Jackson claims, indeed, to have mentioned his hypothesis 
to several persons during this interval ; but this testimony, 
if carefully examined, relates chiefly to a narrative of his 
chlorine gas experiences. In fact, some of Dr. Jackson's 
immediate family had, during this same interval, in 1844, 
submitted to painful tooth extraction by Morton, and yet no 
anesthesia was mentioned then. The hypothesis seems to 
have had for several years a precarious existence. 

The only striking testimony is that of Peabody, a pupil, 
who was advised by Jackson to employ ether in having a 
tooth drawn, but who, after consulting his father, an accom- 
plished amateur chemist, was deterred from doing so by the 
reputed danger, which Jackson's suggestion did not out- 
weigh. But this advice was a year after Wells's experi- 
ments and failure in Boston, and his conversations at that 
time with Jackson. Whenever tooth-pulling was brought 
to Jackson's notice, how could he fail to think of Wells's 
experiments with gas ? And who could think of gas as an 
inebriator, without its co-inebriator, ether? the obvious and 
only possible conclusion being, that what gas had done, 
ether might do, namely, sometimes succeed and sometimes 

8* 



90 DISCOVERY OF ANESTHESIA. 

fail. I have no doubt that this thought did occur to Jack- 
son's mind when tooth-pulling happened to be talked of, 
especially after Wells's experiments. 

It also occurred to Morton's mind. He knew more of 
Wells and of his varying experiments than Jackson did, 
and there is no question that Morton the dentist, oftener 
than Jackson the chemist, dwelt upon painless dentistry. 
His business was "mechanical dentistry," making sets of 
teeth ; and he was daily suffering in purse because patients 
feared to have their teeth drawn, "I will have some way 
yet," said Morton to Gould, in August or September, 1846, 
a short time before the discovery, "by which I will perform 
my operations without pain." "I smiled," replied Dr. 
Gould, " and told him, if he could effect that, he would 
do more than human wisdom had yet done, or than I ex- 
pected it would ever do." 

Who that remembers the late Dr. Gould, cautious, accu- 
rate, truthful, judicial, the friend and brother scientist of 
Dr. Jackson, will doubt this sworn testimony? It was Dr. 
Gould, who, when his wife told him of rumors that Dr. 
Morton had drawn a tooth without pain, under the influence 
of something inhaled, exclaimed, " Yes, that can be done ; 
ether will do it." So obvious was the transition from gas 
inebriation to ether inebriation, from gas insensibility to 
ether insensibility, in the mind of one who happened to have 
his attention drawn to the subject of anaesthesia by inhalation. 

Morton knew of gas, and of Wells. He was in eager 
pursuit of aasesthesia. He believed in it. If he knew, also, 
of ether, he was, in all human probability, on the verge of 
discovery. Did he know of ether? 

It is fortunately established beyond all question that 
Morton made long inquiries about ether in July, and also, a 
short time before the October experiments. If we reject the 
evidence of Wightman and Metcalf on this point, both of 



DISCOVERY OF ANAESTHESIA. 91 

tliera disinterested, accurate, reliable, we must reject all 
human testimony. 

Wightman the philosophical instrument-maker, afterwards 
Mayor of Boston, narrates a long conversation with Morton 
in the cars, when moving his family from his country resi- 
dence to Boston. During this conversation he informed Mrs. 
Wightman, who asked him who Dr. Morton was, "that he 
was a dentist who was experimenting upon the relief of pain 
in dental operations." Wightman fixes the date, September 
28th, of this journey, by items of expense charged in his day- 
book, of which the leaf was produced, as part of his sworn 
testimony. This enables him to fix the time of severnl 
previous conversations with Morton, concerning mesmerism, 
the effects of the imagination, etc., nnd especially of one as 
to whether rubber or oiled silk bags would hold "common 
ether." 

Metcalf, the well-known apothecary, a scrupulously con- 
scientious witness, equally substantiates the date of a con- 
versation half an hour long, about ether, with Morton, who 
held in his hand a bottle of it which he had brought with 
him. In this conversation, "entirely about the inhaling of 
ether," interspersed with anecdotes of exhilaration and 
insensibility, Metcalf told Morton of "a person to whom 
he had given it, who was exceedingly wild, and who injured 
his head while under the influence of it, and did not know, 
when he got over the influence of the ether, that he had 
hurt himself, until it was called to his attention." " Morton," 
Metcalf testifies, "when he went away, knew as much about 
it as I did, for I gave him all the information which I had." 
Metcalf sailed for Europe in July, 1846, just after this con- 
versation. While in Italy, in the early part of 1847, he 
took up a newspaper announcing the discovery, by a Boston 
dentist, of insensibility through ether inhalation. "I said 
at once," testifies Metcalf, "that I was sure Morton must 
be the man, for he was engaged upon ether before I left 



92 DISCOVERY OF ANAESTHESIA. 

home; and that I now knew why he had been so curious, 
and at the same time shy, in his conversation with me." 
To tliose who know Mr. Metcalf this evidence has all the 
weight of personal experience. 

There can be no question that Morton knew about ether. 
How much he knew about it is less important. But it 
should be mentioned that he claims to have made repeated 
experiments with it upon animals in the summer of 1846. 

Morton's explanation of his professed ignorance of sul- 
phuric ether was this. During the summer, while boarding 
at Dr. Jackson's, he had heard frequent and protracted ex- 
positions of Jackson's claim to the invention of the electric 
telegraph, then recent, and the important features of which 
Jackson was satisfied he had communicated to Morse during 
an ocean passage. Dr. Jackson had, indeed, a well-stored 
and suggestive mind, which made it more than likely that 
he had furnished information, of which Morse, while origi- 
nating and mentally evolving a system of electric telegraphy, 
may have been glad to avail himself. A sharp public 
discussion, with pamphlets, ended with a verdict in Morse's 
favour. In going to Jackson, Morton feared that if there 
were any deliberate conference, Jackson might set up a 
similar claim of participation in his own search for painless 
dentistry, and therefore took the shortest way to exhaust 
his knowledge for his own benefit, without discussion. 
There can be little doubt that Morton was in this matter 
reticent, as Metcalf states, and intended to keep it a secret 
from his brother dentists. I am also inclined to believe 
that Morton at first cared little about the abstract question 
of discovery, and would have willingly left a large share of 
any honour unquestioned in the hands of Jackson. But 
when Jackson made a claim upon the patent, and the pro- 
fits, beyond the amount to which Morton conceived him to 
be entitled, then he defined his own claim to the discovery. 
It may be stated in this connection, that the surgeons of 



DISCOVERY OF ANESTHESIA. 93 

the Massachusetts General Hospital, who had no interest 
whatever in tliis difference, and could have none, were friends 
of Jackson, and stranj^ers to Morton. They yielded, when 
it became necessary to take sides, only to their deliberate 
conviction of the justice of Morton's claim. 

It will be advantageous, at this point, to take a genera] 
view of the "ether controversy." For this purpose, I find 
I can do no better than to quote the following letter, written, 
when the occurrences were fresh, to the Hon. Robert C. 
Winthrop, in Washington : — 

January 26, 1848. 
Dear Sir : I believe most fully, that Dr. Morton deserves 
any reward Congress may grant to the discoverer ; because, 
although many people have thouglit that a man could be intoxi- 
cated beyond the reach of pain, Dr. Morton alone proved this 
previous posaihilily to be a certainty, and safe. A diagram will 
make the matter plainer than words : — 

Before October, 1846, Discovery in Oct. After October, 1846, 

■who made the sugges- 1846. Consecutive ex- Morton alone took the 
tion? periments by Morton. responsibility of dan- 

i gar, and proved that it 
■was 

1st. Certain. 
2d. Safe. 



Here is the only 
ground of dispute. 



The two last points, namely, the consecutive experiments, 
and their confirmation, which nobody disputes to Morton, make 
him. in my eyes, the discoverer. 'I'he only doubt is, who made 
the suggestion? To me this is of no importance. Dr. Jackson 
says, "I did. I told Mr. Morton to try the experiment; and 
unless I had so told him, he would never have tried it." Dr. 
Jackson adds: "I first tried ether when I was suffering from 
chlorine, in 1842. I afterwards recommended it to Mr. Peabody." 
But Dr. Morton confutes even these positions. He says to Dr. 
Jackson : " 1st. I show, by the evidence of Dr. Gould, Mr. 
Wightman, and Mr. Metcalf, that I was experimenting with 
ether before the interview in which you claim to have brought it 
to my notice. 2d. In 1842 you only re-discovered what was 



94 DISCOVERY OF ANAESTHESIA 

before clearly in print in Pereira's Materia Medica. 3d. You 
claim that you told Mr. Feabody what you knew of ether. Now 
you could not know it. You have stated all your grounds of 
deduction, and the widest inference you could draw from them 
is, a suspicion of the properties of ether ; and a suspicioji in 
science, an unconfirmed theory, amounts to nothing. Finally, 
what you claim to have discovered in 1842 you kept to yourself 
during four years. Do you expect the world to believe you knew 
its value ? Do you expect it to reward you for letting people 
suffer during that length of time? Besides, the suggestion of 
anaesthetic agencies occurred to Davy; especially was it followed 
out, though unsuccessfully, by Horace Wells, who, disgusted 
with failure, abandoned his attempts." These and others had 
hypotheses as well as Dr. Jackson. Morton alone proved the 
hypothesis. Without Morton there is no evidence that the 
world would have known ether to the present day. I believe this 
covers the ground of important argument and difference in the 

pamphlets 

Respectfully your ob't servant, 

Henry J. Bigelow. 

At the interview referred to, Jackson's partisans tenaci- 
ously insist that he assumed direction, as a physician might 
have done, of the administration of a remedy ; while Morton 
acted only as a "nurse." Let us examine, then, the often- 
quoted "nurse" argument with which the opponents of 
Morton have endeavoured to handicap him at the outset. 
Here is its fallacy. A physician, by common understanding, 
possesses a positive knowledge of the effect of his remedies, 
in advance of their administration. Such knowledge was 
impossible to Jackson. Again, a physician is employed 
expressly to direct, and a nurse to obey. Under these 
circumstances a nurse is not likely to get much credit for 
originality, which is in fact absolutely excluded by the terms 
of her contract. There was no such contract here. Morton 
was not a mere agent, without preconceived plan, automatic 
in action, and irresponsible as to results. On the contrary, 



DISCOVERY OF ANAESTHESIA. 95 

he was already conducting an independent investigation. 
He was in pursuit of anaesthesia when he went to the 
laboratory of Jackson, with whom the subject, even admit- 
ting his claim, had slumbered for years. He had been 
before, and in the same way, to books, apothecaries, instru- 
ment-makers, in short, to various usual and available sources 
of knowledge, as is customary with every investigator or 
discoverer. The purpose, the investigation, the patient, the 
discretion, the responsibility, were all his. Morton was not 
a "nurse." 

Morton had a combination of qualities such as few other 
men in the community possessed. Fertile in expedients and 
singularly prompt in execution, he was earnest and perse- 
vering beyond conception. His determined persistence is 
remembered even at this interval of time, as having been 
a terror to his best friends. Nobody denies that Morton, 
recklessly and alone, faced the then supposed danger at- 
tending ether stupor. If all accredited scientific opinion 
had not been at fault, and in the case of any fatal result, he 
would have infallibly been convicted of manslaughter, with 
little probability that anybody would have come forward to 
say, "The responsibility is not his, but mine." 

In fact. Dr. Jackson endeavoured at this time, by word 
and deed, to keep both himself and his reputation clear of 
Morton, as a reckless and dangerous experimenter. The 
only operations under ether witnessed by him during the 
first three months were on November 21, 1846, and January 
2, 1847 ; and a part of this time he was absent from the 
State. 

"But," it has been a hundred times said, "Jackson made 
a suggestion, and Morton used it." It is evident that we 
cannot escape some discussion of the relation of "sugges- 
tion" to "discovery," no matter how little the suggestion 
may be intrinsically worth, or how fortuitous its success. 
The simple question is, What was the actual value of Jack- 



96 DISCOVERY OF ANESTHESIA 

son's suggestion to Morton at the time it was made — I 
distinctly mean before Morton had handled it? 

A suggestion in science varies in value as much as a 
suggestion in common life, where advice is not always sound 
advice. It may, indeed, turn out fortunately, like a sugges- 
tion, for example, to wager money on the ace of spades. 
But because it may prove so, the advice does not necessarily 
imply merit in the adviser. This is an extreme case. At 
the other extreme is a mathematical certainty, such, for 
example, as that twice two make four: a truth the value of 
which is not afterwards augmented for intelligent people by 
a material test or demonstration that twice two apples make 
four apples. A similar example of mathematical certainty 
is that calculated by Leverrier (liable only to the instru- 
mental fallibility of dividers, telescopes, and equations), 
which did not become more absolute, nor more true, when 
Galle saw the planet where Leverrier told him it must be. 
Mathematics are unerring, while predictions in physiology 
are as uncertain as predictions about the weather a week 
hence. Yet it has been argued that Jackson was Leverrier, 
and Morton Galle. 

Jackson's alleged hypothesis, before Morton took hold 
of it, had only the value of a lottery ticket, which, through 
Morton's unaided, dangerous, and acknowledged efforts, 
drew an immense prize — or of "the cast of a die" — " for in 
that light," says Watt, whose name is identified with the 
history of steam, and the soundness of whose practical views 
no one will dispute, "I look upon every project that has not 
received the sanction of repeated success." A statement of 
the grounds upon which this view is based will enable others 
to draw their own conclusions. Let us begin with Jackson's 
experiments. 

"Having, in 1841-2," says Jackson, "got my lungs full 
of chlorine gas, which nearly suffocated me, I immediately 
had ether and ammonia brought to me, and alternately 



DISCOVERY OF ANESTHESIA. 97 

inhaled them, with great relief." The next clay, still suCfer- 
ing, and "perceiving a distinct flavour of chlorine in my 
Ijreath," the experiment was repeated "with perfectly pure 
washed sulphuric ether," and "with entire loss of feeling." 
"All pain ceased." He "fell into a dreamy state, and 
became unconscious of all surrounding things." 

In other words, he inhaled ether, until, seated as he was 
"in a rocking-chair, with his feet in another chair," he fell 
asleep. So far there was nothing new. Pereira, for ex- 
ample, says {Elements of Materia Medica, etc., London, 
1839, pp. 210-211):— 

"The vapour of ether is inhaled in spasmodic asthma, chronic 
catarrh, and dyspnoea, whooping-cough, and to relieve the effects 
caused hy the accidental inhalation of chlorine gas.'' "When 
the vapour of ether sufficiently diluted with atmospheric air is 
inhaled, it causes irritation about the epiglottis, a sensation of 
fulness in the head, and a succession of effects analogous to 
those caused hy the protoxide of nitrogen (vide p. 156), and 
persons pecidiarly susceptible to the action of the one are also 
poiuerfully affected hy the other. [Journ. Science, vol. iv. p, 158.) 
If the air be too strongly impregnated icitli ether, stupefaction 
ensues." 

Such was contemporaneous knowledge. Jackson's expe- 
rience was identical with that recorded by Pereira. And 
Pereira further distinctly calls attention to the similar effects 
of inhaled gas and inhaled ether, and to the stupefaction 
caused by ether. 

Pereira adds, in regard to the danger of this condition : — 

" In one case this state continued, with occasional periods of 
intermission, for more than thirty hours ; for many days the pulse 
was so much lowered that considerable fears were entertained for 
the safety of the patient. {Op. cit.) In another case, an apoplectic 
condition, which continued for some hours, was produced." 

I shall revert to this subject of danger. 
But Dr. Jackson alleges that he now advanced a step 
9 



98 DISCOVERY OF ANiESTHESIA. 

further, and logically inferred the entire safety and inevitable 
certainty of ether anassthesia, in all cases, and during the 
severest surgery. This was an unwarrantably wide inference, 
as we shall see. 

Further still, Dr. Jackson claims to have invented a method 
upon which the success of his hypothesis largely, as he sup- 
posed, depended"; and he offers this method as evidence that 
he made the hypothesis and the discovery. It is plain that 
a discovery may be in this way rendered more probable. 
Whoever is in possession of a new method is more likely to 
find the way to a new truth. But if the alleged method 
proves to be partly erroneous and partly an old and familiar 
matter, then the proof of alleged discovery is no stronger 
because of it. In fact, just so far as the hypothesis was 
apparently stronger by reason of the method, it becomes 
weaker when the method falls to pieces. Let us, then, 
examine this alleged method. 

Dr. Jackson has from the first insisted upon two points, 
as peculiar to his invention, and essential to his discovery. 
By these safety and certainty are secured, and a neglect of 
them explains previous uncertainty and danger. They are, 

1st. Purity of the ether; 

2d. An admixture with it of atmospheric air. 

If these conditions are either not essential or not new, we 
find ourselves, at least so far as method is concerned, where 
Pereira left us. 

From time immemorial, the familiar way of inhaling ether 
has been with air from a handkerchief. Pereira, as before 
quoted, distinctly stipulates for air. Says another writer, 
"Animals breathe oxygen. Without oxygen a man must 
die. Ether would not have saved Desdemona." This needs 
no ghost for its enunciation. But the fact is, in etherizing 
by a sponge or cloth, the difficulty is as often to exclude 
air enough as to admit air enough. Some good authorities 
maintain that there is advantage in its exclusion — that the 



DISCOVERY OF ANESTHESIA. 99 

insensibility from gas, for instance, is dne to asphyxia. 
Even in etherizing, they aim to take advantage of this con- 
dition by restricting the air supply. The French ether-bag, 
still in use, is expressly arranged for this purpose. In short, 
while it requires especial effort to exclude air, partial 
asphyxia is not dangerous; and a claim to the discovery of 
the safety or certainty of ether stupor based upon the 
admission of air cannot stand. 

A claim based upon pure ether is equally void. Tolerably 
pure ether is better, but by no means essential, for safe 
insensibility. The specific gravity of pure ether is not very 
far from 0.718, and is difficult to attain; that of our usual 
inhaling ether of Powers & Weightraan, 0.724 ; and of 
Squibb {fortior) about the same. The ether of the old 
Pharmacopoeia, and of the shops in the year 1840, was not 
far from 0.750; and this is a very practicable ansesthetic. 
Its slight adulteration with alcohol and acid is not especially 
deleterious, when inhaled. In fact, anaesthesia resembles 
dead-drunkenness, which is equally possible with brandy, or 
with brandy and water. The real danger was not from 
impure ether, but from over-inebriation — a danger which 
exists to-day with the best ether. 

The discovery was not in the admission of air, nor in the 
use of a particular quality of ether. It was, that the inhala- 
tion of ether, which had been familiarly resorted to for years, 
could be prolonged beyond the usual stage of exhilaration 
to a stage of stupor, possessing the complete insensibility of 
a dangerous coma, yet, unlike that condition, safe; and 
that all this could be effected in every case. 

The history of ether anaesthesia was the gradual discovery 
of the following facts: — 

1st. That ether inhaled produced, capriciously, in certain 
instances, unconsciousness. (Old.) 

2d. That it possessed the power of producing stupor in 
every case. (New.) 



100 DISCOVERY OF ANAESTHESIA. 

3d. That this stupor could be exactly graduated as to 
time. (New.) 

4th. That it could be increased or diminished, and arrested 
short of danger, and so made safe. (New.) 

5th. That there were certain infallible indications of 
danger. (New.) 

6th. That, while thus controllable and safe, it could be 
made at will so profound that even amputations should not 
be felt. (New.) 

All that is new belongs to Morton. 

A person inhaling ether from his handkerchief would 
drop it when his hand and senses were benumbed. As air 
entered the lungs he would revive. Such was Jackson's 
self-experiment, already covered by Pereira. But a second 
person, who should now seize the handkerchief and compel 
the continued inhalation to the stage of stupor, might ob- 
viously make a valuable study of this new ground. He 
could draw his patient's tooth, or amputate his leg, and thus 
measure the insensibility. He could repeat the experiment 
until satisfied that insensibility could be always attained, 
and that it was safe. All these experiments Morton tried 
upon others, and when he had tried them the discovery was 
made. 

Jackson virtually claims that his inference extended to 
the universal efficacy, the completeness, and the safety o^ i\\Q 
stupor. 

Of the universal efficacy of the new stupor Jackson could 
have no valuable opinion. Such knowledge was possible 
only through observation of many cases, with an experience 
which could say, "Administer ether as for exhilaration. 
Protract its inhalation beyond this usual stage, and you will 
inevitably reach an ulterior condition of stupefaction. During 
this process a patient may struggle with a giant's force; or 
pei'haps will tell you of his exti'eme distress; or after five 
or ten minutes of inhalation will satisfy medical bystanders, 



DISCOVERY OF ANAESTHESIA. 101 

as patients sometimes do now, that he is not amenable to 
ether. Another will assure you, with apparent reason, that 
he is dying; or, livid with asphyxia, will compress his lips 
and cease to breathe ; or may, for a long time, alternate 
between lividity with a failing pulse, and arterialization with 
a partial return of consciousness.^ But, through all these 
apparently alarming indications, urge the process discreetly, 
and you will ultimately and inevitably reach a stage of 
stupefaction." 

Dr. Jackson could not say all this, because he knew 
nothing of it; nor did anybody else, until Morton established 
the fact that there was no exception to the potency of ether. 
These and other contingencies, once startling, still occur 
with the best ether, and the experience of a quarter of a 
century. Had Morton been a timid or a discreet man, 
anaesthesia might have been delayed beyond the present 
generation. Morton compelled inhalation in spite of indi- 
cations to arrest it, incurred the responsibility of doing so, 
and is entitled to the credit. 

The completeness of the insensibility — its adequacy, for 
example, in amputations — was settled only by repeated 
observation, with varying results, but gradually accumula- 
ting evidence : from the tooth first painlessly extracted, 
through several failures to comparative success in dentistry; 
then the removal of a venous tumour of the jaw, where the 
patient was doubtfully insensible; then a fatty tumour of 
the arm, with complete insensibility; and finally, after an 
inconsiderable operation or two, the amputation of a leg, 
practically successful. Everybody awaited this final test by 
amputation, and then only was the accumulated evidence 

1 Such patients are faiuiliarly known to our hospital attendants 
as "bad etherizers." Some of them are inebriates. If they return 
for a second operation, they seldom fail to exhibit the same symp- 
toms as before. 

9* 



102 DISCOVERY OF ANAESTHESIA. 

deemed conclusive. It was, indeed, beginning to be felt that 
the process was a safe one, and that it promised satisfactory 
results ; otherwise the hospital surgeons would not have 
permitted this test of it in a patient weakened by disease. 
But this experiment, like the rest, so far as anaesthesia was 
concerned, was Morton's, and a part of his well-organized 
enterprise to investigate and establish the new insensibility. 
As this amputation has been repeatedly published as mine, 
it should be stated that it was performed by the late Dr. 
Hayward. That ansBsthesia was employed at all on that 
occasion Alice Mohan has to thank me ; although, if anaes- 
thesia had not been employed in this particular instance, the 
test of amputation would have been delayed only till another 
should occur. The circumstances may illustrate the sort of 
obstacles Morton encountered. The looked-for opportunity 
had arrived; but, through various antagonistic influences, 
Morton, in spite of his earnest request, had been notified 
that ether would not be administered, and that he need not 
attend the operation. Of this he informed me the night 
before, and by arrangement with him I carried him to the 
hospital the next day, just before the operation, there to 
await events. A dose of laudanum had been administered, 
and Alice Mohan was carried to the amphitheatre, for opera- 
tion without ether. I there strongly urged the employment 
of the yet ostensibly secret agent; partly on the ground that 
it then was really known, but especially from the considera- 
tion that humanity ought to supersede any doubts connected 
with professional etiquette. This and other considerations 
prevailed, and, after a delay of half an hour, Morton, whose 
presence had been till then unknown except by me, was 
brought up, and the patient was etherized. 

The evidence of all this slowly accumulating anaesthetic 
surgery, at which Dr Jackson was not present, was claimed 
for him in virtue of the "nurse" argument. What light 
could a repetition of the chlorine experiment of Pereira 



DISCOVERY OF ANESTHESIA. 103 

throw upon the question whether a patient could sleep 
during an amputation ? 

Ether exhilaration was familiar; but, on the other hand, 
it was well understood that ether stupefaction was in certain 
cases dangerous. Physiologists had also found that the 
smaller animals very frequently died of it. Brodie wrote of 
the fresh discovery: "I have heard of this before, and had 
tried it on guinea-pigs, whom it first set asleep and then 
killed. The great question is, Is it safeV This was, 
indeed, the question. Could danger be avoided? what was 
its exact character? and what were its indications? 

On the second of January, nearly three months after the 
discovery, Jackson came to the hospital for the first time. 
To that date, he had been present at one operation only, 
that at the Bromfield House, November 21. He was not 
cognizant of current experiment, and brought voluntarily a 
bag of oxygen, which he urged upon the hospital surgeons 
as a necessary precaution against danger, erroneously sup- 
posed by him, at that late date, to be asphyxia, instead of 
over-inebriation, of which the essential indication is the 
pulse. It was some weeks after the discovery, that this 
source of danger, and its sign, were under.^tood; and in the 
mean time Morton might have killed anybody. A patient 
was, in fact, in great danger from over-inebriation at the 
first private operation. He was inhaling, in the continuous 
way that was at first supposed to be essential to protracted 
insensibility, through a glass globe of ether, and long after 
insensibility was manifested. The operation was far from 
completed, when a bystander happened to feel the pulse. 
There was no special reason for doubt, inasmuch as the 
patient was, in general appearance, like all former thoroughly 
etherized patients. The pulse proved to be barely percep- 
tible, and the patient to be etherized almost beyond recovery. 
The bystander, after repeated observation of other cases, 
published the fact, then first observed, that in ether anses- 



104 J)ISCOVERY OF ANESTHESIA. 

thesia the pulse stood as a beacon between safety and danger, 
between harmless inebriation and fatal narcotism. This 
was the discovery that ether was not dangerous; because 
this showed that its danger gives warning, and is under 
control. The operator was Dr. Dix, the bystander myself, 
and the discoverer Morton. To his impetuous, unremitting, 
reckless experimentation to establish anossthesia, surgeon, 
bystander, patient, ether, and apparatus, were all for the 
time, and in that relation, subordinated. Morton had asked 
me to be present, because I was more familiar with the new 
process than anybody except himself, and for the purpose 
of aiding him, in emergency, with professional advice. But 
the anaesthesia was his. I assumed no responsibility. Had 
the patient died in a "stupor," as he might well have done, 
Morton was liable; and as the patient did not die, his was 
the credit. This was real danger. But there was other 
danger, more startling, though only apparent ; such as 
prostration, "trance," or " mania," lasting for honrs, and 
for which Morton was in one instance threatened with 
prosecution. What was Dr Jackson's responsibility ? None 
whatever. He was then absent from the State. What had 
Pereira's chlorine experiment taught him about all this 
danger ? Absolutely nothing ; nor could it do so. And lie 
could impart nothing. 

In view of these facts, which leave Jackson standing upon 
the naked experiment of Pereira, we may fairly pause, and 
ask. What, in the fullest sense, were the exact significance 
and value of the suggestion made by Jackson to Morton ? 

Caleb Eddy says, in his sworn testimony, "I said to Dr. 
Jackson, 'Dr. Jackson, did you know, at such time, that, 
after a person had inhaled the ether and was asleep, his 
flesh could be cut with a knife without his experiencing any 
pain?' He replied, 'No, nor Morton either: he is a reck- 
less man for using it as he has.' " 

Waiving this testimony, it is clear that the whole of the 



DISCOVERY OF ANAESTHESIA. 105 

peculiar knowledge embraced in tiie suggestion of Jackson 
to Morton would have been accurately and fully conveyed 
in the two words, "Try ether.'- This suggestion should be 
fully credited to Jackson. Morton never questioned the 
fact of the suggestion ; on the contrary, he at once pro- 
ceeded to square the account. Jackson at first distinctly 
agreed to receive five hundred dollars, as full compensation 
for the assistance he had rendered. As the evidence grew, 
and the greatness of the discovery became more apparent, 
Jackson raised his demand to ten per cent, on the sales of 
patent rights. Later, when it was clear that the lottery 
ticket had drawn an immense prize, Jackson again increased 
his demand to twenty-five per cent., which Morton refused. 
The controversy was then opened. 

I very early urged the inexpediency of a patent, if only 
on the ground that, like Whitney's cotton gin, for example, 
this invention was so valuable that the world would com- 
bine, as the event has shown, to take possession of it ; and 
that the question of equivalent might safely be left to pub- 
lic generosity, which has generally recognized such debts. 
Ether anaBthesia was at first opposed on the ground of its 
danger, of quackery, of religion, and of professional etiquette. 
Much of the early opposition to a patent^ came from den- 
tists, who desired to use the new method without pay; and 

• The first statement of the fact of operations under insensibility 
was a paper in the Boston Medical and Surgical Journal, Nov. 18, 
3846, entitled "Insensibility during Surgical Operations, produced 
by Inhalation. Read before the Boston Society for Medical Im- 
provement, Nov. 9, 1846, an Abstract having been previously read 
before the American Academy of Arts and Sciences, Nov. 3, 1846, 
by Henry Jacob Bigelow, M.D., one of the Surgeons of the Massa- 
chusetts General Hospital." A copy of this was sent by a gentle- 
man to his friend. Dr. Boot, of London, and by him transmitted to 
several Loudon surgeons. Their replies to Dr. Boot I have in my 
possession. This paper also announced the patent, and the con- 
nection with it of the names of Morton and Jackson. 



106 DISCOVERY OP AN^STFIESIA. 

they confused with it the question of humanity to suffering. 
But in those days dentists had secret methods to which they 
attached a money value, and which went far to justify both 
secrecy and patent. The question of secrecy should, how- 
ever, be detached from that of equivalent. Dentists and 
physicians, lawyers and clergymen, dealers in food, heat, 
light, labour-saving methods, in short, in comfort, know- 
ledge, and value, rightly exact a pecuniary equivalent, pro- 
portioned to their services, from those who can pay it 
without inconvenience. The more distinctly this is recog- 
nized, the better we shall understand the nature of real 
humanity, and the more readily lend assistance and charity 
to those who need them. Jackson was right in expecting a 
money return for the service he had rendered. The only 
question here is. How much he himself, at first, considered 
a fair equivalent for this service. This has been shown. 

After it became evident that the patent was worthless, 
Jackson repudiated the division, and claimed the whole 
discovery, in virtue of the "nurse" argument. Under these 
circumstances Morton properly insisted that the " sugges- 
tion" could have been picked up from almost any source, 
by any man actively searching for painless dentistry, who 
knew everything about Wells's experiments with gas, and 
who also knew the familiar and similar action of gas and 
ether. Morton was right. 

But Morton also urged that this was a discovery not in 
science, but in art ; that surgical anaesthesia was due, not 
to any great scientific novelty in the long recognized ether 
insensibility, but to his having worked out the application 
of this insensibility to use in art, with enterprise' and perse- 
verance, through many details, in the midst of danger, till 
he gave to the world a perfected system of efficient and safe 
anaesthesia. Morton was again right. 

When a discovery is great, not from the intellect invested 
in it, but because it ameliorates the condition of mankind. 



DISCOVERY OF ANESTHESIA. lOt 

then its recognition has more of a business character, and 
the gratitude and honour bestowed by the world are more 
nearly an equivalent for value received. The world does 
not concede the equivalent until it has received the value ; 
and it is apt to examine with business exactness the claims 
of those who profess to have acted as agents in the matter. 
This suspicion' of discoverers who do not appear until 
after the world has been made to recognize the discovery 
is justiBed by the fact that hardly an invention of import- 
ance was ever made known that it was not at once claimed, 
often simultaneously, from a variety of sources. This is 
not remarkable. The world, whether in science or in art, 
is built up to a certain point by the easy and wide trans- 
mission of knowledge. Upon this elevation stands a multi- 
tude of philosophers, engaged often in identical researches, 
and possessed of much information upon the subject in ques- 
tion. Each of these may honestly believe that his imperfect 
knowledge is the perfected knowledge in question. In such 
a case the world'is liable for a short time to confound claims, 
to confuse the incomplete result of a few data with the com- 
pleted demonstration from many, the unproved with the 
indisputable, theory with fact. Recognize this fallacy, and 
the question of invention is comparatively simple. Yet it is 
not recognized. There is at this day the same claim to 
priority in invention as existed half a century ago. The 
writer of a Life of Fulton then said : "Those who question 
Mr. Fulton's claim are precisely those who have been un- 
successful in their own attempts ; and it would seem that 
exactly in proportion as their efforts were abortive, and as 
they had thrown away money in fruitless experiments, their 
claims rose in their own estimation and that of their parti- 
sans." The witness — I believe before the House Commons 
— probably did not overstate the matter when he gave it 
as his opinion, that, if a man were to show that he had 
found a road to the moon, his neighbours would testify. 



108 DISCOVERY OF ANyESTHESTA. 

that, if they had not been there themselves, they knew 
several persons who were familiar with the road in ques- 
tion. It is hardly too much to say, that, at the present 
day, every invention or discovery having a large supposed 
value is systematically contested. 

Morton, in his attitude of investigator, had a right to 
receive a hint or suggestion of greater solidity than that of 
Jackson, without impairing his merit as inventor. Every 
invention is preceded by such hints or suggestions derived 
from experiment, books, or people. Curtis (on Patents) 
says: "It is clear that many suggestions may have been 
made, or many hints taken from others, without invalidating 
the claim of a party to be considered as the author of the 
invention." 

Of a hundred instances easily cited to illustrate this, let 
us confine ourselves to a medical one, that of the invention 
of vaccination to avert smallpox. 

The young countrywoman of Sodbury said of smallpox: 
" I cannot take that disease, for I have had'cowpox." The 
Duchess of Cleveland, when Lady Mary Davis and other 
companions taunted her as likely to deplore the loss of that 
beauty which was her boast, as the smallpox was then raging 
in London, said that she had no fear about her beauty, for 
she had had a disorder which would prevent her from ever 
catching the smallpox. Were these discoverers ? Surely, 
yes, if Dr. Jackson was one. In fact, the hint that they and 
others gave to Jenner in the vale of Gloucestershire, where 
he resided, embodied more knowledge of vaccination than 
Dr. Jackson's suggestions did of ether anijssthesia.^ But 

^ The experiences of the milkmaid and the Duchess might easily 
have apprised them of their own immunity from smallpox. But 
Jackson, through his chlorine experiments, could have no evidence 
that ether stupor was capable of aflfecting all persons, or that it 
gave immunity from real surgical pain, or was free from danger. 
No self-experiment could touch these points. 



DISCOVERY OF ANESTHESIA. 109 

neither the milkmaid nor the Duchess of Cleveland was 
ever honoured as a discoverer of truth, or an inventor of 
method, while Jenner was so honoured. The reason is 
obvious. They, like Dr. Jackson, asserted a doubtful fact, 
and had neither time nor inclination to pursue the subject; 
but Jenner, by multiplying instances of the cowpox inocu- 
lated like smallpox, which was already supposed to be, like 
smallpox inoculation, protective, conclusively proved that 
it was thus protective, and also safe. He did with cowpox 
what Morton did with ether. 

The parallel in this case is very close. Jenner and Morton 
were in pursuit of what the scientific world regarded as a 
chimera. Because they believed in its possibility they 
encountered prejudice and opposition. They both received 
from others a hint, suggestion, or surmise, which afterwards 
proved to be capable of development into a truth of great 
value. This suggestion was based on narrow induction, 
and had, therefore, obtained no previous general credence. 
It had also slumbered for years at that stage of its develop- 
ment. The world had not believed it. 

Jenner and Morton, both men of singular persistence and 
perseverance, took hold of this idea, of which, from the 
nature of their daily pursuits, they felt the immense value. 
But for them it might have sluuibered indefinitely. They 
dragged it through till the world recognized it and them. 
This they did at the risk of injuring people's health, of 
killing them, and of being held responsible for so doing. 
Nobody has ever doubted that Jenner was the inventor of 
vaccination, and nobody should doubt that Morton was the 
inventor of modern anaesthesia. Here the parallel ceases. 
The English people voted Jenner a reward of $150,000.^ 

' In decisions relating to discovery, unanimity is not to be ex- 
pected. There can be none where partisanship and large interests 
are involved. The question, then, is. Where the weight of evidence 
10 



no DISCOVERY OF ANESTHESIA. 

The world demands convincing demonstration — and not 
by an individual for himself or to himself, but to them and 
for them, with overwhelming clearness. Then, and not till 
then, it responds with acknowledgment, concession, or 
gratitude. 

Sydney Smith, in the Edinburgh Revieiv, insists on this. 
In fact, he wittily overstates the claim of the mere publisher 
of a novelty, when he says that "he is not the inventor 
who first says the thing, but he who says it so long, loud, 
and clearly, that he compels mankind to hear him."^ 

lies. Even Jenner, with no rival, encountered great hostility botli 
to himself and his discovery. The House of Commons (.June 2, 
1802) voted him ten tliousand pounds by a vote of 59 to 56, a 
majority of three only. A further sum of twenty thousand pounds 
was voted (June 29, 1807) by a vote of 60 to 47, a majority of 
thirteen. Morton's award of $100,000, for his patent, passed the 
Congressional Committee. It was arrested, not wholly by Jackson, 
but by the partisans of Horace Wells, who published what after- 
wards filled an octavo volume, containing little argument, but full 
of bitter invective against Morton, and promised, if only delay were 
granted, to make a conclusive case for Wells. 

1 It is easy to understand what is meant here. For instance: I 
have amputated more legs after applying a tight bandage from foot 
to hip before tightening the tourniquet, than in any other way. 
Similarly to the arm for a needle in the hand. A hundred surgeons 
have done the same thing. Sir Charles Bell went a step further, 
and announced the dry method in print. "I may here observe," 
he says, /'that by the management of the tourniquet, blood may be 
lost or gained. If the limb be uniformly rolled before amputation, 
the veins are emptied into the general system, and blood is saved 
instead of being withdrawn. In a very exhausted state of the 
patient, it may be of service to attend to this." {Great Operations 
of Surgery, London, 1821, p. 58.) But Esmarch was so impressed 
with its importance, that he erected it into a system, and urged it 
upon the attention of every surgeon in the civilized world. To 
many the idea was new. In fact, to a considerable part of the 
surgical world Esmarch was the discoverer of an important truth. 
He deserves to be avowed as such, in requital of his pains to perfect 



DISCOVERY OF ANESTHESIA. Ill 

Thus put, however, the statement throws light on Jack- 
son's prominence after the discovery. An unproved hypo- 
thesis in physiology, which was his whole claim, would usually 
be considered of little account. But Jackson knew the 
machinery of fame. As Wells by accident, so Jackson by 
his scientific relations, and through his friend and former 
teacher, Elie de Beaumont, got at once possession of the 
scientific rostrum of the French Academy of Sciences and 
other foreign learned societies. He also subsequently 
addressed Humboldt. He thus compelled the European 
world, even so far as Turkey, to listen to his exclusive state- 
ment that the whole was his. In the mean time, however, 
there was in Boston a scientific jury of the vicinage. 
When Morton's statement at last crossed the water, the 

and to publish to the surgical world, a useful point, new to many 
of them. He is so recognized. 

Antiseptic precautions in surgery are not new ; but Lister pub- 
lished his views, as did Esmarch. Whether germs are essential to 
the theory or not, there can be little doubt that it is well to free a 
wound from coagula. and to wash it out with diluted carbolic acid 
or its equivalent. Then the subsequent free use of the antiseptic, 
by hindering decomposition without, tends to maintain vitality 
within the wound. These views have been enforced and brought 
home to the world by Lister, with the pertinacity of Jenuer or of 
Morton. The world at large owes its attention to these points to 
Lister's announcements, and properly attaches his name to the 
antiseptic method. 

Mere publicity is notoriety ; but with merit it is fame ; with 
originality it is discovery. To all these publicity is essential. He 
who keeps his discovery comparatively to himself discovers, or 
uncovers, nothing. If he claims to have done so, the world will 
scrutinize and suspect his claim. 

The act of publication, indeed, adds little to the claim of Morton ; 
his impregnable position being that he elaborated and perfected a 
new art. But facts like the above go far to show that the failure 
of Jackson for four years to publish his alleged guess, of itself ex- 
tinguishes any claim to its recognition during that time. 



112 DISCOVERY OF ANESTHESIA. 

French Academy did what it could at that late day, and 
awarded to Morton the same honour and recognition it 
conferred upon Jackson. It could do no less. It could 
then do no more. But had the case been at the outset 
reversed, and had Morton made a suggestion to Jackson, 
does anybody doubt that the humbler Morton, and his 
suggestion, would have been by scientific precedent wholly 
absorbed and assimilated? 

All honour, then, to the inventor of the art of anaesthesia ! — 
for there was little science in it. He found the practice of 
ether inhalation an amusement of chemical lecture-rooms 
and schools; he left it the sovereign anodyne of the human 
race in its moments and hours of agony. He found ether 
stupor as hazardously uncertain as was the narcotism pro- 
duced by pouring down the opium ''ct boire^^ of Canappe ; 
he left it as manageable and safe as the sleep that follows a 
dose of laudanum. 

There is hardly an inhabitant of the civilized world but 
can remember some one of those nearest to him in whose 
experience the anguish of the knife or of disease, of birth or 
of death, has been assuaged by anaesthesia, perhaps converted 
into a pleasant dream. Yet he is willing to take this price- 
less boon as a gratuity from those whose sole patrimony it 
was, and who have been brought nigh to want that he might 
enjoy it. If the world should cancel a fraction of its debt, 
the family of the inventor could afford to be generous to the 
families of his former friends, who, without impairing his 
title to the discovery, contributed to his success. 

Wells's sad story has been told. Morton fell with apo- 
plexy, induced by a publication in behalf of Jackson, of a 
nature to prejudice a subscription then arranged in New 
York for his benefit. Jackson, it is to be feared, is at the 
present time hopelessly bereft of reason. 



SURGERY 



BY 
S. D. GROSS, M.P, LL.D., D.C.L. Oxox, 

PROFESSOR OF SCTRGERY IN THE JEFFERSON MEDICAf. COLLEGE OF PHILADEI,PHI A. 



10* 



SURGERY.' 



" According to this time it shall be said, what has God wrought?" 

A CENTURY has elapsed since the American colonies, 
through their representatives in Congress, assembled in 
this city, absolved their allegiance from the British crown, 
and, after a struggle of seven years, attended with great 
sacrifice of blood and treasure, achieved their independence 
as a free and sovereign people. What the country has 
done since that eventful epoch, in the various pursuits and 
occupations of life, is a legitimate object of inquiry, espe- 
cially at a moment when the Nation, now composed of forty 
millions of human beings, is about to celebrate its Centen- 
nial Anniversary, in a form intended to display, in the 
amplest manner, its mental and physical wealth. It is 
well that every profession once in a century should open 
its ledgers and examine its accounts to see how it stands 
with itself and with the world at large. 

The progress of the arts and sciences is intimately asso- 
ciated with the intellectual development of the human race. 
No nation can be truly great, if unmindful of the sanitary 
condition of its citizens. Civilization and the arts of do- 
mestic life march hand in hand; as is the one, so necessarily 

' The author tenders his acknowledgments to Professor Grreene, 
of Portland, Professor Bell, of Louisville, Professor Johnston, of 
Baltimore, Dr. George A. Otis, and Dr. Harvej G. Brown, U. S. A., 
and Dr. Laurence Turubull, Dr. William Thomson, and Dr. L Minis 
Hays, of Philadelphia, for material embodied in this paper. 



116 SURGERY. 

must be the other, so indissolubly are they interwoven and 
bound together. The refined and cultured physician has 
been an object of the deepest interest in every enlightened 
age and country. Even the American savage, who cares 
little for his physical comforts in his native wilds, has his 
" medicine man" to ease him of his pains when overtaken by 
disease or accident. In ancient Greece and Rome, those 
great centres of civilization in the Old World, the physician 
was held in the highest esteem and veneration. The beau- 
tiful and complimentary remarks of Cicero are familiar to 
every classical scholar, and meet with a ready response in 
the heart of every right-thinking person. The praises of 
the surgeon have been sung in poetry and heralded in 
prose the world over, and there has been no important 
military enterprise since the first great battle was fought 
in freedom's cause, in which he did not play a conspicuous 
part. If in the exercise of his humane duties, he does not 
always receive the plaudits of his countrymen, he never 
fails to obtain the approval of his own conscience, often 
the only reward coveted by true merit and unaffected modesty. 
The examples of Ambrose Pare and of Baron Larrey afford 
striking illustrations of the happy influence which the mili- 
tary surgeon is capable of exerting over the minds of sol- 
diers in times of war, in inspiring confidence in their leaders 
and in their own personal safety when struck down by 
accident or disease. When the father of French surgery 
appeared at Metz, invested by the army of Charles Y., the 
soldiers, exhausted by hunger and fatigue, crowded around 
the great surgeon the moment they saw him approach, ex- 
claiming, " we have no longer any fear of dying even if we 
should be wounded ; Pare, our friend, is among us ;" and 
the great Napoleon declared that Larrey, who followed him 
through all his campaigns, was the most honest and upright 
man he had ever known. 

In considering the contributions which have been made 



SURGERY. 117 

by America to surgical art and science during the last hun- 
dred years, the object of this paper, it will be necessary to 
arrange them under different heads instead of presenting 
them in chronological order or historical sequence. In 
speaking of the honoured dead, I shall not confine myself 
to a mere enumeration of their labours, but append, when- 
ever it may be convenient, brief biographical sketches, so 
as to place their true character more fully before the reader. 
Of the living I shall, for obvious reasons, say little, if any- 
thing, beyond what more immediately concerns their con- 
tributions to the general stock of American surgery. In 
carrying out this design it will be my earnest endeavour to 
do full justice to all my surgical brethren, in all sections of 
the country, engaged in the legitimate exercise of their 
profession ; at the same time, however, it must be under- 
stood that the limits within which I am restricted will pre- 
vent me from entering into any minute details. It will be 
perceived that most of the prominent surgeons mentioned 
in this paper have been teachers in medical schools, and it 
is hardly necessary to add that they must have exercised 
more or less influence in moulding the surgical mind of the 
country. Not a few of them were the worthy peers of Roux, 
Lisfranc, and Dupuytren, of France; of Abernethy, Cooper, 
Brodie, and Lawrence, of England ; of Cusack, Crampton, 
and Colles, of Ireland ; of Bell and Syme of Scotland ; of 
Graefe and Rust, of Germany, and of Scarpa and Porta, of 
Italy ; men who in their respective countries stood head and 
shoulder in talent, influence, skill, and attainment, above 
most of their contemporaries. 

Although this paper is designed to record the achieve- 
ments of American surgeons, there are, strange to say, as 
a separate and distinct class, no such persons among us. 
It is safe to affirm that there is not a medical man on this 
continent who devotes himself exclusively to the practice 
of surgery. On the other hand, there are few physicians, 



118 SURGERY, 

even in our larger cities, who do not treat the more com- 
mon surgical diseases and injuries, such as fractures, dislo- 
cations, and wounds, or who do not even occasionally per- 
form the more common surgical operations. In short, 
American medical men are general practitioners, ready, 
for the most part, if well educated, to meet any and every 
emergency, whether in medicine, surgery, or midwifery. 
Of late, the specialists have seriously encroached upon the 
province of the general practitioner, and, while they are 
undoubtedly doing much good, it is questionable whether 
the arrangement is not also productive of much harm. The 
soundest, and, therefore, the safest, practitioner is, by all 
odds, the general practitioner, provided he is thoroughly 
educated, and fully up to his work. 

The century under review opened with no great lights 
in practical surgery. Although the Revolutionary War 
had furnished a large number of army surgeons, who ren- 
dered important service both on the field and in the hos- 
pital, there was not one among them who was entitled to 
the term great, in the sense employed at the present day. 
The nearest approaches to such a distinction were Dr. Wil- 
liam Shippen and Dr. John Warren, the first professors, 
respectively, of anatomy and surgery in the University of 
Pennsylvania and Harvard College. Dr. Benjamin Rush 
acted at first as Physician, and afterwards as Surgeon- 
General to the Middle Division of the army, and doubtless 
discharged well the duties of his offices; but it must be 
remembered that he was educated as a medical practi- 
tioner, not as a surgeon, and there is no record which goes 
to show that he ever performed any of the great operations 
of surgery. Dr. James Tilton also rendered good service; 
but his special province seems to have been the supervision 
of hospitals, and, in a general way, the care of the sick and 
wounded. How active and energetic he was in the per- 
formance of his varied and responsible duties, and how 



SURGERY. 110 

horoughly he had studied military hygiene, his little tract, 
entitled ^^ Economical Observations on Military Hospitals 
and the Prevention and Cure of Diseases incident to an 
Army,^^ published in 1813, at Wilmington, Delaware, suf- 
ficiently attests. It is proper to state that a portion of 
this tract was submitted, at the request of the Secretary 
of War, as a report to a committee of Congress, of which 
Kobert Morris, the eminent financier of the Revolution, 
was chairman, and that it met with the warm approval of 
Government. There is reason to believe that Dr. Tilton's 
long, earnest and thoughtful services were instrumental in 
saving many lives. He was fully aware of the pernicious 
influences of hospitals, and he, therefore, availed himself, 
whenever practicable, of open tents for the accommodation 
of the sick and wounded. The motto of his tract was bor- 
rowed from Homer's Iliad: — 

On mules and dogs the infection first began. 
And last the baneful arrow fixed in man. 

Tilton served during our late war with England, and died 
at an advanced age in 1822. Delaware may justly claim 
him as one of her most distinguished sons. 

Rush, like Tilton, distinguished himself as a hospital 
physician, and during the war published a pamphlet em- 
bodying the results of his observations on the diseases of 
soldiers ; a brochure widely disseminated and of great bene- 
fit to army surgeons. This great and good man died, in 
1813, at the age of sixty-eight years. Dr. John Warren, 
whose active life began with the Revolutionary War, in 
which he was a Surgeon-General, died in 1815. His 
career was crowded with political events, and his name is 
indissolubly associated with the rise and progress of medi- 
cal institutions in Massachusetts. 

Two surgeons, of great name and renown, flourished con- 
temporaneously with John Warren, although they were 



120 SURGERY. 

both by many years his juniors ; while two others, destined 
to become equally illustrious, had just entered upon their 
brilliant career a short time before Warren died. These 
men, whose names are as familiar with the profession as 
household words, were Philip Syng Physick, born at Phila- 
delphia in 1768; John Collins Warren, of Boston, born in 
1778; Valentine Mott, of New York, born at Glen Cove, 
Long Island, in 1785; and Benjamin Winslow Dudley, of 
Lexington, Kentucky, born at Spottsylvania, Virginia, in 
1785. Out of the loins of these men have issued, either 
directly or indirectly, many of the great surgical practi- 
tioners of the past and present day in this country. 
Wright Post, a native of Long Island, a surgeon of great 
note in his day, was born two years before Physick, and 
died in 1822. He was appointed Professor of Surgery in 
the Medical College of New York in 1792, and performed 
many highly creditable operations. 

John Syng Dorsey, a nephew of Physick, and a native of 
Philadelphia, was born in 1783. He was the author of the 
first treatise on surgery ever published in this country ; a 
work in two volumes, extensively used as a text-book in our 
schools, and also for a considerable period in the University 
of Edinburgh. After having completed his foreign studies 
he settled in Philadelphia, where he soon acquired a large 
practice, and became one of the most popular men in the 
community. He contributed a number of valuable papers 
to the medical press, was the first in the United States to 
ligate the external iliac artery, and, at the time of his death, 
which occurred in 1818, before he had attained his thirty- 
fifth year, he was Professor of Anatomy in the University of 
Pennsylvania. 

The name of Ephraim McDowell will be forever famous 
in the history of surgery as the originator of ovariotomy. 
Although a native of Virginia, he earned his reputation at 
the town of Danville, Kentucky, where he practised his pro- 



SURGERY. 121 

fession from an early period of his life until the time of his 
death, in 1830, in the fifty-ninth year of his age. His medi- 
cal education was acquired mainly in the University of Edin- / 
burgh, and in the lecture room of the celebrated John Bell 
of whom he was a great admirer. His first case of ovari- 
otomy occurred in 1809. He was a successful lithotomist 
and commanded a large field of practice. The chaplet that 
should have been worn on his brow has been placed by a 
grateful profession upon his tomb. 

One of the most extraordinary medical men whom this 
country has ever produced, whether we regard his great 
ability as a general practitioner, his skill and daring as a 
surgeon, or his versatility as a teacher of the different 
branches of medicine, was Nathan Smith, of New Haven, 
who, after a brilliant career, died in 1829, at the age of 
sixty-seven years. He w^as a native of Rehoboth, Massa- 
chusetts, a professor in Dartmouth, Yale, and Bowdoin col- 
leges, and the author of a monograph entitled a Practical 
Essay on Typhous Fever. This wonderful man, a true pioneer 
in the cause of medical education, lectured early in life upon 
all the branches of medicine then taught at Dartmouth Col- 
lege, and enjoyed for a long time almost an unrivalled repu- 
tation as a surgeon, teacher, and general practitioner in the 
New England States. In his tract on fever he shows himself 
to have been a sagacious observer, thoroughly acquainted 
with the nature and treatment of the disease which he has 
so well described. 

Dr. John Beale Davidge, a native of Annapolis, was the 
founder of the University of Maryland, in which he occu- 
pied for many years the chairs of anatomy and surgery. He 
enjoyed a high reputation as a teacher, and as a practitioner 
of medicine, surgery, and of midwifery. As a writer, he 
occasionally contributed to the periodical press; and he is 
said to have possessed a considerable amount of literary 
11 



122 SURGERY. 

attainment. He died in 1829, at the age of sixty years, 
leaving behind him an enviable name. 

George McCIellan, a contemporary of Physick, Mott, 
Warren, and Dudley, was born at Woodstock, Connecticut, 
in 1796, and became distinguished early in life as a bold and 
dashing operator, and as a fascinating, enthusiastic, and in- 
structive teacher. He was the founder of the Jefferson 
Medical College of Philadelphia, in which he was the pro- 
fessor of surgery from 1825 until 1838, and the author of a 
work entitled The Principles and Practice of Surgery , edited 
as a posthumous production by his son, the late Dr. John 
H. B. McCIellan. McCIellan died in 1847, in the fifty-first 
year of his age. 

Jacob Randolph, a man of prominence in his day, will be 
remembered chiefly in connection with his efforts to popu- 
larize lithotrity in this country, an operation in which he 
obtained considerable reputation as a skilful manipulator. 
Born in Philadelphia in 1796, he was for a number of years 
a hospital surgeon, and for a short time Professor of Clinical 
Surgery in the University of Pennsylvania. He contributed 
some valuable papers to the periodical press, and wrote an 
able and graphic memoir of his father-in-law, Dr. Physick. 
"Dr. Randolph," writes one of his biographers, "was en- 
dowed in a high degree with all the attributes of the great 
surgeon." His death occurred in 1848, in the fifty-second 
year of his age. 

William Gibson, a native of Maryland, occupied the chair 
of surgery in the University of Pennsylvania from 1818 until 
1854, when advancing age and bodily infirmity compelled 
him to resign. He was an accomplished lecturer, a lucid 
writer, an able operator, and the author of a work entitled 
The Institutes and Practice of Surgery, extensively used as 
a text-book in its day. Dr. Gibson had the good fortune 
to be the first surgeon that ever tied the common iliac artery. 



SURGERY. 123 

an operation which contributed greatly to the extension of 
his reputation. 

Among the surgeons who occupied a conspicuous place 
in this country, as teachers and practitioners, during the 
middle of the present century, may be mentioned the names 
of Thomas Dent Mutter, Daniel Brainard, David Gilbert, 
George Hayward, and George W. Norris. Mutter, a native 
of Virginia, and for fifteen years Professor of Surgery in the 
Jefferson Medical College of Philadelphia, distinguished 
himself as a polished, forcible, and popular teacher, and as 
an able plastic surgeon. lie died in 1859, leaving his 
surgical museum to the College of Physicians of Philadel- 
phia, together with $30,000 for its increase, and for the 
endowment of what is known as the Miitter lectureship in 
that institution. Brainard, born in 1812, in the State of 
New York, was the founder of Rush Medical College of 
Chicago, and for many years its professor of surgery. His 
essay on ununited fractures, in which he advanced some 
novel methods of treatment, received the prize of the Am- 
erican Medical Association, at its meeting at St. Louis, in 
1854. A bold operator and a successful practitioner, he 
was an excellent teacher, an original thinker, and a good 
writer. He died in 1866, after having held for many years 
the leadership of surgery in the northwestern States of the 
Union. Gilbert, whose death occurred in 1868, at the age 
.of sixty-five, was a native of Pennsylvania, and for a num- 
ber of years Professor of Surgery in the Pennsylvania Medi- 
cal College of Philadelphia- He was distinguished as a 
skilful operator, as well as an excellent general practitioner; 
and, although his surgical exploits were not numerous, they 
were of such a nature as to make his name widely known. 
Hayward, a contemporary and for many years a colleague of 
John C. Warren as Professor of Clinical Surgery at Harvard 
University, was one of the leaders of his profession in New 
England, enjoying a large reputation as an operator, and as 



124 SURGERY. 

a general practitioner. He was the first to make known 
among us the writings of Bicliat, having translated his 
immortal work on general anatomy, a task which of itself 
entitles him to no ordinary praise. Dr. Hayward was born 
in 1791, and died in 1863, at the aj^e of seventy-three years. 
Dr. George W. Norris, a Pliiladelphian by birth and edu- 
cation, for many years surgeon to the Pennsylvania Hos- 
pital, will be remembered chiefly by his essay on ununited 
fractures, and by his statistics of the results of operations 
upon the larger arteries, of fractures, and of amputations, 
published originally in the American Journal of the Medical 
Sciences, and collected a short time before his death, in 1815, 
in an octavo volume entitled Contributions to Practical Sur- 
gery. Dr. Norris was for a short time Professor of Clinical 
Surgery in the University of Pennsylvania. His great 
forte was conservative surgery, in which he achieved some 
of his proudest triumphs. 

To the above list must be added the name of John Phea 
Barton, whose operative skill placed him, a third of a century 
ago, in the foremost rank of his contemporaries. Although 
he was essentially a mechanical surgeon, he was not the less 
an excellent diagnostician, and an able general practitioner. 
To him the profession is indebted for the invention of a 
valuable operation for the relief of anchylosis, mentioned in 
another part of this paper, and also for an admirable account 
of fracture of the inferior extremity of the radius, known as 
Barton's fracture. He was also the first to suggest the use 
of the bran-dressing, so useful in the treatment of com- 
pound-fractures and dislocations of the leg, and he devised 
an excellent bandage for fractures of the lower jaw. As an 
expert lithotomist, he had few rivals in his day. After 
having been engaged for twenty years in active practice, 
Dr. Barton retired to private life, wealth, it is said, having 
allured him from his profession. He died in 1871. 

Four New York surgeons deserve honourable mention in 



SURGERY. 125 

connection with the brilliant career of Valentine Mott, of 
whom all were contemporaries, if not at some time or an- 
other colleagues — Richard S. Kissam, J. Kearney Rodgers, 
Alexander H. Stevens, and John Watson, all hospital sur- 
geons, and two of them excellent writers, one a distinguished 
teacher, and all able operators and skilful practitioners. It 
is said of Kissam, who died in 1822, that of sixty-five cases 
of lithotomy which passed through his hands only three 
proved fatal ; a degree of success eminently creditable to his 
skill and judgment. J. Kearney Rodgers, born at New 
York in 1793, a pupil of Wright Post, and afterwards of 
Sir Astley Cooper, Travers, Abernethy, and Sir B. C. 
Brodie, founded, alo!ig with Dr. Edward Delafield, the New 
York Eye and Ear Infirmary, and was, for many years, one 
of the surgeons of the New York Hospital. He was distin- 
guished for his great practical tact, his ability as a diag- 
nostician, and his great adroitness and elegance in the use 
of the knife; but, above all, for his many manly and noble 
traits of character. His great operation, one which made 
his name known throughout the world, was the ligation, in 
1846, of the left subclavian artery between the scalene mus- 
cles. His death occurred in November, 1851. Alexander 
H. Stevens, who died only a few years ago at a ripe old 
age, spent in retirement at his residence at Astoria, Long 
Island, distinguished himself early in life by his translation 
of a portion of Boyer's treatise on Surgery, and, subse- 
quently, by the publication of several valuable surgical 
memoirs; he was one of the surgeons of the New York 
Hospital, and for a number of years professor of surgery in 
one of the New York medical colleges. Asa clinical teacher, 
he enjoyed a high reputation, and was greatly beloved for 
his amiuble and excellent qualities. John Watson, a native 
of Londonderry, Ireland, where he was born in 1807, immi- 
grated to New York at an early age, and soon became dis- 
tinguished as an able practitioner^ a classical scholar, an 

II* 



126 SURGERY. 

admirable writer, and an acute critic. He was for a long 
time surgeon to the Xew York Hospital, was a skilful 
operator, and was a copious contributor to the medical 
press, especially to the pages of the American Journal of 
the Medical Sciences. His Medical Profession in Ancient 
Times, published in 1856, is a highly creditable production. 
He had one of the largest and choicest collections of the 
works of the fathers of the profession in this country. Dr. 
Watson died at a comparatively early age. 

To the above catalogue must be added the name of a 
distinguished surgeon, Dr. George Bushe, an Irishman, 
brought over to this country by the faculty of the Rutgers 
Medical College of New York, in 1828, as professor of 
anatomy in that school on the recommendation of Mr., after- 
wards Sir William, Lawrence. Bushe died young, leaving 
behind him a brilliant reputation as a bold, dashing operator, 
and as the author of the well-known standard monograph 
on the Diseases of the Anns and Rectum, long, if indeed not 
still, the ablest work on the subject in any language. He 
also published a memoir on staphylorraphy, and was the 
founder and editor of the Neiv York Medico- Chirurgical 
Bulletin, an able journal of brief duration. 

Granville Sharp Pattison, a name well known in America 
and Europe, was a Scotchman, and a pupil of xillan Burns, 
of Glasgow, the author of the great work entitled Observa- 
tions on the Surgical Anatomy of the Head and Nech, of 
which he brought out an edition in this country. In 1820 
he was appointed Professor of Surgery in the Uqiversity of 
Maryland, and on retiring from that institution he occupied 
successively the chair of anatomy in the London University, 
in the Jefferson Medical College, and in the University of 
the City of New York. Although he was not a great sur- 
geon, he was one of the ablest teachers of surgical anatomy 
of the age, and by his enthusiasm as a lecturer he had the 
happy faculty of inspiring his pupils with a love for surgery 



SURGERY. 127 

such as few men ever possessed. He contributed a number 
of valuable papers to our periodical literature, and was for 
some time one of the editors of the Philadelphia Medical 
Recorder. Dr. Pattison died at New York in November, 
1851, aged sixty years. 

Northern New England can boast of two representative 
surgeons, of great, if not unsurpassed, ability as practi- 
tioners and operators, both natives of New Hampshire, men 
of great renown, and of unsullied character. I allude to 
Amos Twitchell, of Keene, born in 1781, and Dixi Crosby, 
for many years the distinguished Professor of Surgery at 
Dartmouth College. Both of these men performed a vast 
amount of work in their day; they both possessed uncom- 
mon skill in the use of the knife ; and such was the con- 
fidence reposed in their judgment, ability, and integrity, 
that patients flocked to them from all sections of the New 
England States for aid and advice, often in cases of great 
emergency and suffering, in which relief had been sought 
in vain in other quarters. Twitchell, whose life was closed 
in May, 1850, performed many bold and difScult operations; 
but the crowning glory of his life, as remarked by his biog- 
rapher. Dr. Albert Smith, of Dartmouth, was the ligation 
of the primitive carotid artery in a case of secondary hem- 
orrhage, a feat which he executed successfully in 1807, eight 
months prior to Sir Astley Cooper's famous case, supposed, 
until recently, to have been the first of its kind upon record. 
Of Dr. Crosby, whose recent death was so widely deplored 
as a great loss to his country and his profession, nothing 
further need be said here, as the following pages bear ample 
testimony to his skill and judgment as a great surgeon. 

Thomas Hubbard and Jonathan Knight, of New Haven ; 
Alban Goldsmith, of New York; Horatio G. Jameson, of 
Baltimore ; John Wagner, James Ramsay, and John Bel- 
linger, of Charleston ; Joshua B. Flint, of Louisville; P. C. 
Spencer, of Petersburg ; Joseph Parrish, Joseph Harts- 



128 ^ SURGERY. 

borne, Thomas T. Hewson, William E. Horner, and Thomas 
Harris, of Philadelphia, were well-known surgeons in their 
day, distinguished either as teachers, as operators and 
practitioners, or as contributors to our periodical literature. 
The popularity of Professor Knight, as a gentleman and an 
honoured member of the profession, was shown by his having 
been twice elected President to the American Medical As- 
sociation, a compliment never before nor since accorded to 
any of its members. Dr. Hewson, a son of the celebrated 
London anatomist, was for nearly a third of a century a 
hospital surgeon. Dr. Harris was a naval surgeon, who 
late in life held the office of Chief of Bureau at Washington 
City. Among those who closed their earthly career, either 
quite recently or at a comparatively recent period, stand 
conspicuously the names of Horace A. Ackley, Reuben D. 
Mussey, and George C. Blackman, of Ohio ; of Charles A. 
Pope, of Missouri ; of J. Tyler Bradford, and James M. 
Bush, of Kentucky ; of Thomas B. Buchanan, of Tennessee ; 
of Warren Stone, of Louisiana ; of Josiah C. Nott, of Ala- 
bama; of Charles Bell Gibson, Hugh Holmes McGuire, and 
John P. Mettauer, of Virginia; of Paul B. Goddard, John 
H. B. McClellan, and George W. Norris, of Pennsylvania; 
of Alden March, Ernst Krackowizer, and James A. Armsby, 
of Xew York; and J. Mason Warren, and Winslow Lewis, 
of Massachusetts. 

It is not probable that America will ever again produce 
four surgeons of equal renown with Philip Syng Physick, 
John C. Warren, Valentine Mott, and Benjamin W. Dudley, 
for the reason that it is not at all likely that an equal number 
of young practitioners will ever again be placed under equally 
advantageous circumstances for their development. When 
Physick commenced the practice of medicine in Philadelphia 
there was no surgeon of any prominence north of New York, 
and very few of any distinction even on that side of the line. 
He returned after an absence of four years with the prestige 



SURGERY. 129 

of foreign study, as a favourite pupil of the celebrated John 
Hunter, and he had hardly touched his native shore before 
there was a frightful outbreak of yellow fever in his own 
city, carrying off not less than 4000 of its inhabitants in 
1793. Physick was at once appointed physician to the Bush 
Hill Fever Hospital, where, as well as in the city, then com- 
paratively small, he was brought into contact with many pro- 
minent citizens, a circumstance highly favourable, one would 
suppose, to his speedy introduction into practice ; and yet 
practice came so slowly that he for some time seriously con- 
templated abandoning the profession and settling upon a 
farm. Gradually, however, this chilling and discouraging 
feeling, so often experienced by the young aspirant after 
fame, wore off, and long before he had reached the meridian 
of life, he stood at the head of his profession as the first sur- 
geon on the American continent. His appointment to the 
chair of Surgery in the University of Pennsylvania, in 1805, 
greatly promoted his interests, and was a means of attract- 
ing patients to him from all parts of the country. Upon the 
death of John Syng Dorsey in 1818, Physick was transferred 
from the surgical to the anatomical chair, which he occupied 
until 1831, when advancing age and increasing physical in- 
firmities compelled him to retire. 

The Father of American surgery, a title well deserved 
because well earned, died in 183t, in the sixty-ninth year of 
his age, having only a short time before that event per- 
formed several important operations, among others that of 
lithotomy upon the venerable Chief Justice Marshall, from 
whose bladder he removed upwards of one thousand calculi. 
Physick has left no works to commemorate his fame or to 
record his vast experience, a few short papers in the medical 
press of the day comprising the whole of his contributions 
to the surgical literature of the country. In Dorsey's Ele- 
ments of Surgery may be found an abstract of the experience 
of the first twenty-five years of his surgical practice. Physick 



130 SURGERY. 

was deeply imbued with the doctrines of his illustrious pre- 
ceptor, John Hunter, and constantly advocated their im- 
portance in his lectures, thus contributing, in no small 
degree, to their dissemination and appreciation in this 
country, and, more or less directly, to the advancement of 
American surgery. As a surgeon, it may be truly said of 
Physick, what Dr. John Brown has said of Mr. Syrae, that 
he never spilt a drop of blood uselessly, or, as a teacher, 
ever wasted a word. 

John C. Warren was a son of John Warren, the first 
professor of anatomy and surgery in Harvard College, and 
a nephew of General Joseph Warren, who lost his life at 
the battle of Bunker Hill. On the death of his father, in 
1815, he succeeded to his two chairs, which he occupied 
for upwards of a quarter of a century; he was for a long 
time surgeon to the Massachusetts General Hospital, and 
there was no medical man in the Xew England States who 
was so favourably known, or who commanded so wide an 
influence as an operator and general practitioner. From his 
aristocratic descent and his oflBcial relations, it is evident 
that John C. Warren had a sort of pre-emption right to 
the surgery, not only of Massachusetts, but of all the sur- 
rounding States. He was the author of a work on Tumours, 
was a large contributor to the periodical press, and was the 
first who ever administered ether as a preventative of pain 
in a surgical operation. 

Yalentine Mott, in the thirty-fourth year of his age, tied 
the innominate artery, a feat never accomplished before, and 
on waking up the next morning found himself "the observed 
of all observers." Other great operations followed in more 
or less rapid succession, and fame soon perched upon his 
brow, carrying his reputation into all parts of the civilized 
world. When Mott, after his return from Europe, settled 
in Xew York, his only surgical competitors, of any note, 
were Wright Post and Richard S. Kissam, good but not 



SURGERY. 131 

great surgeons. He had thus an open field, whicli he long 
successfully occupied, although latterly not without many 
able competitors, and even rivals, up to the time of his 
death in 1865. 

B. W. Dudley, in 1810 went to Europe, where he availed 
himself of the instructions of Cline, Abernethy, and Cooper, 
in London, and of Boyer, Dubois, Larrey, and others in 
Paris. Bringing back with him French manners, which he 
affected during the remainder of his life, he settled at Lex- 
ington, Kentucky, then a small village, in 1814. Upon the 
organization of Transylvania University in 1819, he was 
appointed professor of anatomy and surgery, the latter posi- 
tion of which he held until the school was finally closed in 
February, 1850. Dudley early in his career had no com- 
petitor. Ephraim McDowell, a resident of Danville, Ken- 
tucky, only 36 miles from Lexington, had, it is true, already 
performed ovariotomy several times as well as many other 
important operations, but the former of these feats, instead 
of enhancing his reputation, only served to bring him into 
ridicule, if not positive contempt, both at home and abroad. 
In all the great West and Southwest there was not one 
surgeon of commanding skill, talent or reputation. A great 
field here lay fallow, and Dudley soon, of necessity, became 
its occupant and its successful cultivator; so true is it that 
circumstances more frequently make men than talent and 
genius, or great and intrinsic merit. Dudley was a great 
advocate of protracted rest and low diet in the treatment of 
chronic inflammation, and of the bandage as a means of con- 
trolling swelling and muscular action in the treatment of 
wounds, fractures, and dislocations. Indeed, he might be 
said to have been the knight of the roller, so generally did 
he employ it, and so strongly advocate its utility. His dis- 
ciples, less skilled in its application, of course committed 
many egregious blunders with it, causing much suffering with 
the occasional loss of a limb, and a suit for malpractice. 



132 SURGERY. 

Dudley expired in January, 1870, in the eighty-fifth year of 
his age, most of his time, since he delivered his last lecture, 
in 1850, having been spent in retirement, in a species of 
gradually increasing imbecility. 

In connection with these men, who were the surgical auto- 
crats of their day in this country, must be mentioned the name 
of Dr. Warren Stone, who, in point of reputation and pro- 
fessional pre-eminence, occupied the same position in the 
Southern States that they, respectively, did in the Eastern, 
Northern, and Western. Born at St. Albans, Vermont, 
February 8th, 1808, Stone settled early in life at New 
Orleans, where he soon acquired a degree of popularity 
seldom equalled in any walk of life. A man of talents and 
of wonderful kindness and benevolence, he was an attractive 
talker, and a boon companion, with a smile and a cordial 
shake of the hand for every one who approached him. The 
boatmen of the Mississippi and Ohio Rivers literally wor- 
shipped him. As he grew in reputation, nobody could be 
sick without having Stone, either as attending or consulting 
surgeon or physician. He was the great commoner in his 
day in the South ; tall of stature, not particularly refined or 
elegant in his address, but so kind and winning in his man- 
ners as to inspire his patients with unbounded confidence in 
his ability and skill. The great secret of his success lay in 
his large heart and in the native powers of his mind, strong 
and well poised, but not at all cultured. When he passed 
away, in December, 1872, the Southern people mourned his 
loss as the loss of a household god. Stone has left no sub- 
stantial memorial of his labours. His vast experience, as 
a surgeon and physician, is buried with his ashes. Au- 
thorship had no charms for him. He was not a great, much 
less a brilliant, operator; and, as a teacher of surgery, he 
was too erratic and too unsystematic to do justice to the 
chair which he held for a third of a century in the University 
of Louisiana. When he settled at New Orleans the only 



SURGERY. 133 

surgeon of any note was Dr. Charles A. Luzenberg, a man 
of elegant manners, an excellent scholar, and a brilliant prac- 
titioner, as well a dexterous operator, who died in 1847, 
thus leaving the field to his young rival, who had already 
for several years past been treading closely upon his heels. 

All these men, and many others equally good, although 
not equally distinguished, have passed away. Had the lot 
of the very foremost of them been cast in our day, they 
would have had many competitors, and not a few successful 
rivals in the race of fame. In short, they never would have 
attained such wondrous pre-eminence. If circumstances did 
not make them what they were, circumstances powerfully 
contributed to their development, and in giving saliency to 
their character. None of them were brilliant; none even 
uncommonly talented. The men now upon the stage have 
nothing to be a-shamed of; educated more or less thoroughly, 
they are fully equal to their work, and are, in every respect, 
worthy successors in an age when science and skill occupy 
a much more exalted position than they did in the days of 
the Father of American Surgery. 

In the Surgery of the Bloodvessels^ America need not be 
ashamed of her achievements, of which some have certainly 
been eminently daring and brilliant. Commencing with 
that on the vessels of the neck, it may be stated that the 
common carotid arteries have been ligated in innumerable 
instances, both on account of hemorrhage in wounds of the 
cervical region and in their continuity for the cure of aneu- 
rism and of morbid growths. The first operation in which, 
on this continent, the primitive carotid artery was secured 
with a double ligature was performed in 1803, by Dr. Mason 
Fitch Cogswell,^ of Hartford, Connecticut, the procedure 
having been rendered necessary during the extirpation of a 
** scirrhous tumour" of the neck, in which that vessel was 

' N. E, Journ. of Med. and Surg., vol. xiii. p. 357. 
12 



134 SURGERY. 

deeply embedded. The ligature came away at the end of 
two weeks, and the man lived until the twentieth day, when 
he died exhausted from general debility, hastened by slight 
bleeding from a small vessel near the angle of the jaw. Dr. 
Cogswell, who was an army surgeon in the Revolutionary 
War, died in 1830. In its continuity, the artery, if I am 
not in error, was first tied .in this country in 1813, by Wright 
Post/ of New York, in a case of aneurism, followed by the 
recovery of the patient. To Dr. Macgill,^ of Maryland, 
belongs the credit of having been the first to secure success- 
fully both carotids, after an interval of one month, on account 
of a fungous growth in the orbit of each eye, the operations 
having been performed in 1823, four years after that of 
Dupuytren and Robert. Altogether, this procedure has 
been executed fifteen times on this side of the Atlantic, with 
the result of 11 recoveries, 2 deaths, and 2 failures. The 
operators were Macgill, Mussey, Mott, F. H, Hamilton, 
John Ellis, J. M. Warren, George C. Blackman, Reynolds 
and Van Buren, Willard Parker, J. R. Wood, J. C. E. 
Weber, J. M. Carnochan, and H. E. Foote. The caused 
necessitating the operations were, for the most part, epi- 
lepsy, erectile tumours, or malignant growths of the orbit 
of the eye. In Carnochan's"^ case it was performed for the 
relief of elephantiasis of the neck, face, and ear. In one 
of Mott's cases,* where the interval of the application of 
the two ligatures was only fifteen minutes, death ensued 
within twenty-four hours. In Dupuytren and Robert's case 
the interval was thirty-six years, a sufficient reason for 
excluding it from the list, as the parts had long ago accom- 
modated themselves to the changes induced in the cerebral 

' Am. Med. and Phil. Register, vol. iv. p. 366. 

2 N. Y. Med. and Phys. Journ., vol. iv. p. 576. 

3 Am. .Journ. Med. Sci., .July, 1867, p. 109. 

^ Mott's Velpeau, edited by Blackman, vol. 1. p. 867. 



SURGERY. J35 

circulation by the first operation. Mott tied the common 
carotid artery altogether fifty-one times, in most of the cases 
successfully. During my pupilage in this city, in 1827, I 
assisted the late Dr. George McClellan in ligating this 
vessel in a child only five months old, on account of an im- 
mense ntcvus on the upper part of the face. The descending 
branch of the ninth pair of nerves was divided in the opera- 
tion, as it interfered with the passage of the ligature. The 
infant speedily recovered, without, however, any material 
benefit as it respected the morbid growth. Mott,^ in a 
similar case, tied the artery successfully, followed, it is said, 
by a cure of the aneurism, in a child only three months of 
age. A case was reported in 185t by Dr. Gurdon Buck,^ 
of New York, in which, on account of a deep wound of the 
parotid region, a ligature was successfully applied by that 
gentleman simultaneously to the common and internal carotid 
arteries. Two examples of a similar kind have occurred 
since that period: one, in 1871, in which Professor W. T. 
Briggs,^ of Nashville, tied both these vessels, on account of 
secondary hemorrhage after an operation for the cure of a 
traumatic aneurism of the common carotid artery; and the 
other, in 1872, in which they were secured by Professor A. 
B. Sands,* of New York, on the tenth day after excision 
of the left half of the lower jaw. Both patients recovered. 
In September, 1875, Dr. Donald Maclean, Professor of 
Surgery in Michigan University, Ann Arbor, in a case of 
traumatic aneurism, cut down upon the tumour, and, turning 
out the clots, tied the common carotid at both ends. 

The innominate artery was approached for the first time 
with a ligature on the 11th of May, 1818, the operator being 

' Am. Journ. Med. Sci., Nov. 1830, p. 271. 

2 Ibid., Jan. 1856, p. 267. 

3 Nasliville .Journ. Med. and Surg., March, 1871, p. 103. 
* New York Med. Journ., Jan. 1874, p. 34. 



136 SURGERY 

Dr. Valentine Mott. The patient was Michael Bateman, 
fifty-seven years of age, the subject of an aneurism of the 
right subclavian artery, the tumour being of large size, weil 
marked, and the seat of much suffering. The artery was 
tied about half an inch below its bifurcation; the ligature 
was detached on the fourteenth day; on the ninth day there 
was some hemorrhage, and again on the twenty-third, but 
in larger quantity; and death occurred on the twenty-sixth 
day from exhaustion. The dissection revealed absence of 
occlusion, and extensive ulceration of the structures at the 
lower part of the neck, involving the innominate artery. Dr. 
Richard Wilmot HalV of Baltimore, repeated the operation 
in 1830; in 1859 it was performed by Dr. E. S. Cooper, of 
San Francisco ;2 and in 1864 by Dr. A. W. Smythj^of New 
Orleans, who at the same time ligated the common carotid 
artery. In this case, which finally, after repeated attacks 
of hemorrhage, terminated successfully, the fortunate result 
was manifestly due to the ligation of the vertebral nrtory on 
the fifty-fourth day after the primary operation. The par- 
ticulars of Dr. Mott's case will be found in the New York 
Medical and Surgical Register for 1818, and also in Town- 
send's translation of Velpeau's Operative Surgety. This 
operation, which reflects imperishable credit upon Dr. Mott, 
as a skilful and daring surgeon, was performed before he 
had been thirteen years in active practice. Having made 
himself thoroughly familiar with the surgical anatomy of the 
neck, he had no hesitation in attempting it, satisfied that he 
possessed the requisite courage, judgment, and dexterity to 
complete it. The case of Dr. Smyth is replete in interest, 
not only as illustrative of extraordinary ability of the ope- 
rator, but as showing how recovery may occasionally occur 

' Baltimore Med. and Surg. Journ., vol. i. p. 125. 

2 Am. Journ. Med. Sci., Oct. 1859, p. 395. 

3 Ibid., July, 186G, p. 281. 



SURGERY 13Y 

under, apparently, the most desperate circumstances. It 
is proper to add, that, in all the other cases, amc^inting to 
upwards of a dozen, in which the innominate artery was tied, 
the result was unfavourable, the immediate cause of death 
being secondary hemorrhage. 

The subclavian artery has been repeatedly secured on the 
capular aspect of the scalene muscles, both for the arrest of 
hemorrhage and the cure of aneurism. The first successful 
operation for the cure of aneurism, in this country, if not in 
the world, was performed by Dr. Wright Post^ in 1817. 
The credit arising from the case is greatly enhanced by the 
fact that the operation, a very delicate one, had previously 
failed in the hands of such " master spirits in surgery," as 
Ramsden, Abernethy, and Cooper. Ligation of the sub- 
clavian artery on its tracheal aspect, originally executed by 
Mr. Colles, of Dublin, has, I believe, been performed only 
three times in this country, the surgeons being Valentine 
Mott,' J. Kearney Rodgers,' and Willard Parker * Until 
the operation was done by Rodgers, such an attempt was 
universally regarded as impracticable on the right side for" 
the relief of aneurism, from the close proximity of the vessel 
to the sac of the pleura and the intimate relations of the 
tumour with the thoracic duct and the great vessels and 
nerves of the neck. The patient succumbed under the effects 
of secondary hemorrhage on the fifteenth day. In 1863, 
Professor Parker,^ also in a case of aneurism, performed a 
similar operation, at the same time securing the common 
carotid and vertebral arteries, in the hope of thus effectually 
preventing the occurrence of secondary hemorrhage. Despite 

• Trans. N. Y. Phys.-Med. Soc, vol. i. p. 387. 

2 Am. Journ. Med. Sci., Aug. 1833, p. 354. 

3 Ibid., April, 1846, p. 541. 

* Ibid., April, 1864, p. 562. 

5 Am. Med. Times, March 5, 1864, p. 114. 
12* 



138 SURGERY. 

of tin's precaution, however, the patient died from tliis cause 
at the end of the sixth week. There are two cases, one in 

1867 by J. C. Hutchison,^ of Brooklyn, and the other in 

1868 by A. B. Sands, ^ of New York, in which a ligature 
was placed in immediate succession upon the common carotid 
and subclavian arteries for aneurism of the innominate An 
instance in which the carotid alone was secured for a similar 
disease occurred in 1867, in the hands of Dr. Addinell Hew- 
son,^ of Philadelphia. Statistics go to show that ligation 
of the carotid alone is generally a more rapidly fatal opera- 
tion than the simultaneous ligation of this artery and of the 
subclavian. Dr. Thomas G. Morton^ in 1866, in a case of 
spontaneous axillary aneurism at the Pennsylvania Hospital 
in a man fifty-one years of age, tied the left subclavian artery 
between the scalene muscles, the patient finally recovering, 
after amputation of the limb at the shoulder-joint, rendered 
necessary by sloughing of the tumour, followed on the forty- 
third day by secondary and frequently recurring hemorrhage, 
and eventually by mortification, of the extremity. 

Professor Pancoast, many years ago, suggested a more 
easy method than the one usually adopted for tying the 
subclavian artery below the clavicle, particularly applicable 
to cases of aneurism of the neck reaching so far down as to 
allow little space for exposing the vessel. The operation 
consists in opening the fissure between the sternal and 
clavicular attachments of the great pectoral muscle, when 
the former is cut across immediately below the collar-bone, 
and the artery is sought for and ligated. 

Sir Astley Cooper, in 1817, executed the daring and 
brilliant feat of ligating the abdominal aorta in a man thirty- 

• Med. Record, vol. 2, p. 265. 

2 Ibid., vol. 3, p. 531. 

3 Peiin. Hosp. Rep., vol. i. p. 219. 

1 Am. Journ. Med. Sci., July. 1867, p. 70. 



SURGERY. 139 

eight years old, on account of an aneurism of the left iliac 
artery; and, although the ease terminated fatally, it has 
induced a number of other surgeons to follow his example. 
In this country the operation was performed for the first 
and only time, in 1 868, by Professor McGuire,^ of Richmond, 
Virginia, the patient being a man thirty-six years of age, the 
subject of aneurism of the external and common iliac arteries, 
involving the lower portion of the aorta. Death occurred 
within eleven hours after the operation. 

Ligation of the common iliac artery was first practised 
in 1812, by Dr. William Gibson,^ of Baltimore, afterwards 
Professor of Surgery in the University of Pennsylvania, for 
the arrest of hemorrhage caused by a gunshot wound of 
the abdomen. Death occurred on the fifteenth day, from 
gradual loss of blood. The first case in which the opera- 
tion was performed successfully for the cure of aneurism was 
that of Dr. Mott^ in 1827. Among American surgeons who 
have tied this vessel for aneurism may be mentioned the 
names of Charles A. Luzenberg, Edward Peace, Warren 
Stone, A. J. Wedderburn, W. A. Van Buren, Stephen 
Smith, L. A. Dugas, Alban Goldsmith, William Hammond; 
and for the arrest of hemorrhage, those of Alfred Post, 
Willard Parker, and Gurdon Buck.* In the latter case, 
one of aneurism of the femoral artery, ligatures were suc- 
cessively applied to the femoral, profunda, external iliac, 
and common iliac. In Dr. Stone's^ case, fatal on the 
twenty-sixth day, the artery was included in a silver wire 
ligature, probably the first instance of the kind on record. 
In a case in the practice of the late Dr. George Bushe,'"' 

' Am. .Tourn. Med. Sci., Oct, 1868, p. 415. 

2 Am. Med. Recorder, vol. 3, p. 185. 

3 Phila. Journ. of Med. and Phys. Sci., vol. xiv., p. 176. 

4 Am. Journ. Med. Sci., .July, 1860, p. 24. 

5 Ibid., Oct. 1859, 570. 

6 N. Y. Med.-Chir. Bulletin, vol. i. p. 55. 



140 SURGERY. 

Professor of Anatomy in Rutgers Medical College, New 
York, the right common iliac artery was succesfully tied in 
a child only six weeks old on account of extensive telangiec- 
tasis of the perineum, genital organs, anus and rectum. The 
difficulties of such an operation, at so tender an age, were 
immense, and could only have been surmounted by the most 
consummate skill. 

The internal iliac artery was first successfully tied in 1847 
by S. Pomeroy White/ of Hudson, afterwards of New York, 
for gluteal aneurism. Among other operators have been V. 
Mott, J. Kearney Rodgers, H. J. Bigelow, Gilman Kimball, 
and Thomas G. Morton. 

The external iliac artery was tied for the first time in the 
United States in 1811 by John Syng Dorsey,*^ in a case of 
inguinal aneurism, the patient making a good recovery. It 
was the eighth operation of the kind ever performed, the first 
having occurred in the hands of Mr. Abernethy in 1796. 
Ligation of the sciatic artery for aneurism of this vessel, 
and subsequently, on account of secondary hemorrhage, of 
the common iliac, has been practised by L. A. Dugas,^ of 
Georgia. Death followed on the fourth day. In a case of 
ligation of the external iliac, the aneurism adhered so firmly 
to the peritoneum that the operator, Wright Post,-* of New 
York, in order to separate it, was compelled to cut through 
that membrane, notwithstanding which the patient made an 
excellent recovery. 

The gluteal artery has been tied twice in this country 
for the cure of aneurism ; first by Dr. John B. Davidge, 
of Baltimore, and, secondly, by Dr. George McClellan^ of 

' Am. Journ. Med. Sci., Feb. 1828, p. 304. 

2 Eclectic Repertory, vol. ii. p. 111. 

3 Southern Med. and Surg. Journ., Oct. 1859, p. 651. 

4 Am. Med. and Phil. Reg., April, 1814, p. 443. 

5 Mott's Velpeau, edited by Blackman, vol. i. p. 795. 



SURGERY 141 

Philadelphia. Both patients recovered, although they had 
lost much blood. 

In my memoir of Dr. Mott, published in 1868, occurs the 
following paragraph in relation to the ligation of arteries 
by this wonderful surgeon : — 

" No surgeon, living or dead, ever tied so many vessels, or so 
successfully, for the cure of aneurism, the relief of injury, or the 
arrest of morbid growths. The catalogue, inclusive of the cele- 
brated case of the innominate artery, comprises eight examples 
of the subclavian artery, fifty-one of the primitive carotid, two 
of the external carotid, one of the common iliac, six of the ex- 
ternal iliac, two of the internal iliac, fifty-seven of the femoral, 
and ten of the popliteal ; in all one hundred and thirty-eight." 

The first successful cure of aneurism by digital compres- 
sion occurred in 1847, in the practice of the late Professor 
Knight,^ of New Haven. The case was one of popliteal 
aneurism. In two instances of subclavian aneurism, in the 
hands of J. Mason Warren,^ too far advanced for ligation, 
a cure was effected by direct compression of the sac, aided 
by the application of bags of ice. 

Until a very recent period the idea was very common 
among surgeons, even the most enlightened and experienced, 
that the ligation of a vein, especially a large one, was almost 
uniformly productive of very grave consequences, occasion- 
ally followed by death. How utterly unfounded this opinion 
is, has been abundantly proved by the able and exhaustive 
statistical paper of Dr. S. W. Gross, of Philadelphia, pub- 
lished in the January and April numbers of the American 
Journal of the Medical Sciences for 1867. 

The metallic ligature for the ligation of arteries, an Ame- 
rican device, is much less frequently employed than, in my 
opinion, it deserves to be. Such a substance can, of course, 

• Am. Journ. Med. Sci., July, 1848, p. 255. 

2 Surgical Observations with Cases, Boston, 1867. 



142 SURGERY. 

never take tlie place of the ordinary ligature in the case of 
the smaller arteries, but for the larger trunks nothing could 
possibly be more eligible, especially when an operation is 
performed for the cure of aneurism, in which it is always very 
desirable to avoid suppuration, an occurrence which is almost 
inevitable when the common ligature is used from its tendency 
to act as a seton or foreign body. The metallic ligature is 
a non-irritant, and, if properly applied, is sure, in a sound 
artery, to become speedily encysted, remaining thus ever 
afterwards as a harmless tenant. This never happens with 
the ordinary ligature, which therefore never fails to keep up 
discharge until it is detached, whether its retention be short 
or long. The innocuous character of the metallic ligature 
w^as first satisfactorily demonstrated by the late Dr. Henry 
S. Levert, of Mobile, Alabama, while a student in Phila- 
delphia, in a series of well-conducted experiments upon the 
inferior animals, performed at the suggestion of Dr. Physick, 
the results being embodied in his inaugural dissertation 
which was afterwards published, by order of the Faculty of 
the University of Pennsylvania, in the Americari Journal of 
the Medical Sciences for 1829. So far as my information 
extends, 'the late Dr. Warren Stone,^ of New Orleans, was 
the first to apply a wire ligature to a human artery. The 
case, which occurred in 1859, was one of aneurism of the 
external iliac, for which he tied the common trunk of that 
vessel. In 1866, a similar operation was performed by Dr. 
C. H. Mastin,^ of Mobile, upon the external iliac, for an 
inguinal aneurism; and about the same time I secured that 
vessel for a similar purpose. Since then I have applied the 
silver wire ligature to other arteries, and have had every 
reason to be satisfied with the results of the treatment. If 
surgeons only knew, or knowing, considered the advantages 

» Am. Journ. Med. Sci., Oct. 1859, p. 570. 
^ Ibid., Oct. 1866, p. 580. 



SURGERY. 143 

of the metallic ligature, I feel confident that it would be 
much more frequently, if not generally, employed. An 
account of a series of interesting experiments upon metallic 
ligatures, performed by Dr. Benjamin Howard, will be found 
in the New York Medical Record for 1868, and a paper 
illustrative of the same subject, by Dr. F. D. Lente, of Cold 
Spring, New York, in the American Journal of the Medical 
Sciences for April, 1869. 

Dr. A. M. Pollock, of Pittsburgh, in 1859, conceived the 
idea of employing the wire loop as a substitute for the liga- 
ture, and he has adopted the method with great success in 
a number of amputations and other operations. The chief 
advantages which he claims for this treatment are, the more 
frequent union of the wound by the first intention, less 
'danger of secondary hemorrhage, equal facility of applica- 
tion, and removal at the pleasure of the operator. The first 
case in which the wire loop was used by Dr. Pollock oc- 
curred in January, 1860. In an article tn the New York 
Medical Journal ^ov July, 1869, he has given an account of 
twenty-six amputations, in which this. procedure was adopted, 
including forty-seven arteries, of which seventeen were fe- 
moral. Ingenious contrivances for suppressing hemorrhage 
have been devised by Professor N. R. Smith, of Baltimore, 
and Dr. S. F. Speir,^ of Brooklyn. Of the intrinsic value 
of these different methods of treatment, it would be prema- 
ture to attempt to form an estimate, as they have not been 
sufficiently tested, or sanctioned by the experience of the 
profession. 

The practice of employing animal ligatures originated 
with Dr. Physick early in the present century, under the 
conviction that they would occasion much less irritation 
than ordinary ligatures, then, and still so much in use. The 
substance which he selected for the purpose was buckskin, 

1 Med. Record, April, 1871. 



144 SURGERY. 

cut into suitable strips, which were then rolled upon a 
marble slab to impart to them the requisite degree of hard- 
ness, roundness, and smoothness. Dr. Dorsey, after numer- 
ous experiments with various kinds of animal substances, 
performed at the instance of Physick,* was induced to give 
the preference to French kid, divested of its coloured and 
polished surface ; and such was his confidence in the safety 
of this material, when properly prepared, that he employed 
it in various amputations, and in a number of capital opera- 
tions, always cutting off the ends close to the knot, and 
treating the wound as if no ligature had been used. He 
found that in the course of a few days the ligature was com- 
pletely, or almost completely, dissolved in the wound without 
any detriment to the artery. Dr. Hartshorne, of Philadel- 
phia, soon after, in a case of amputation of the thigh, tied 
up the bleeding vessels with strips of parchment. Dr. Ho- 
ratio G. Jameson,-^ of Baltimore, at a later period, employed 
the buckskin ligature. He found, as the result of his expe- 
riments upon dogs, sheep, and other animals, that, if pro- 
perly managed, it soon becomes surrounded with a cyst or 
capsule, which itself finally disappears through the agency 
of the absorbents. Dr. John Bellinger, of Charleston, and 
Professor Eve, of Nashville, have made more or less exten* 
sive use of the sinew of the deer. Whether the animal liga- 
ture has fallen into merited neglect, I will not stop to in- 
quire ; certain it is that it is seldom employed at the present 
day. I have myself always preferred the ordinary silk 
thread, well waxed, and firmly applied. 

For taking up deep-seated arteries, when accidentally 
divided, Physick,^ in 1794, suggested the use of a pair of 

' Eclectic Rep., vol. vi. p. 389, aud Dorsey's Surgery, 2ded., vol. 
i. Phila. 1818. 

2 Medical Recorder, January, 1827. 

3 Dorsey's Surgery, 2d edit., vol. ii. p. 182. 



SURGERY. 145 

curved forceps, holding in its jaws a short curved needle, 
armed with a silk ligature. He was led to this idea by the 
difficulty which he experienced in throwing a ligature around 
the internal pudic artery, a vessel which he had the misfor- 
tune to divide in his first case of lithotomy, performed with 
the gorget. A useful instrument for taking up deep-seated 
arteries in their continuity, as in the operations for aneurism, 
was devised, many years ago, by the late Drs. Parrish, Hew- 
son, and Hartshorne of Philadelphia, and is usually known 
by their names. 

Most surgeons of the present day are agreed that almost 
the only safe operation for the cure of Varicose Veins is 
subcutaneous ligation. The substance commonly preferred 
for this purpose is the metallic ligature, first employed, if I 
mistake not, nearly at the same time by Dr. Richard J. 
Levis, of Philadelphia, and Dr. Xathan Bozeman, of New 
York, the former fastening the wire with a twist or knot, 
and the latter with his well-known button. Professor Eve, 
of Nashville, prefers the animal ligature, being of opinion 
that it is less likely to cause irritation than any other sub- 
stance. He employs the same material in the treatment of 
varicocele. When this affection is accompanied by extra- 
ordinary elongation of the scrotum, he first retrenches the 
parts and then ligates the enlarged and tortuous vessels. 
With this view, after having pushed the testicle up to the 
inguinal ring, he seizes the redundant skin with a long, nar- 
row pair of fenestrated forceps, and cuts it away with one 
sweep of the bistoury, taking care not to expose the vaginal 
tunic. The edges of the wound being transfixed with a 
number of pins, placed at suitable distances, the forceps are 
removed, when the enlarged veins are separated from the 
spermatic artery and deferent tube, and included in one 
animal ligature, drawn sufficiently tight to arrest the circu- 
lation. The wound is now closed with twisted sutures, made 
by fastening the pins, of which there are generally from six 
13 



146 SURGERY. 

to a dozen, with threads passed around each in the form of 
the figure 8. 

In connection with the subject of varicocele, it may be 
mentioned that one reason, probably, of the exemption of 
the right spermatic vein from this affection, is the presence 
at the opening of this vessel into the inferior cava of a 
distinct valve, first described by Dr. John H. Brinton,^ of 
Philadelphia, no such arrangement existing on the left side. 

In the treatment of Fractures of the long bones, we are, 
it may fairly be assumed, decidedly in advance of every 
other nation. One of the first improvements introduced 
into practice early in the present century was the modifica- 
tion of Desault's splint by Physick for the treatment of frac- 
tures of the leg and thigh. The original splint, as is well 
known, reached only to the level of the crest of the innomi- 
nate bone. Physick, discerning its defective construction, 
prolonged the outer splint to the axilla, giving the upper 
extremity the form of a crutch, and inserting two mortise 
holes for the reception of the counter-extending band. The 
improvement thus made was marked. Within the last six- 
teen years a valuable addition, suggested by Dr. H. Lenox 
Hodge, ^ of Philadelphia, has been made to the long splint, 
consisting of a bar of wrought iron, furnished with movable 
bolts, and bent to the right or left, in accordance with the 
seat of the fracture. To the bar a long broad strip of adhe- 
sive plaster stretched along the front and back of the trunk, 
and arranged in a loop above, is fastened, and this, in turn, 
is secured to the chest by three horizontal bands. Thus 
constructed the apparatus is, probably, as perfect as any con- 
trivance of the kind can possibly be. However this may 
be, it has now given way, in great measure, if not entirely, 
both in private and in hospital practice, to the admirable 

' Am. Joura. Med. Sci., July, 1856, p. 111. 
2 Ibid,, April, 1860, p. 565. 



SURGERY. 147 

mode of treatment introduced in 1861 by Dr. Gurdon Buck/ 
of New York, in which long splints are entirely dispensed 
with, and the extension made with adhesive strips, fastened 
to the leg, and secured below the sole of the foot to a cord, 
playing over a pulley, and controlled by a bag of shot or 
other suitable contrivance, weighing from five to fifteen 
pounds, according to the age of the patient. The counter- 
extension is made with India-rubber tubing passed round 
the groin and perineum, and attached to the head of the 
bedstead. 

The anterior splint, as it is named, of Professor N. R. 
Smith, ^ of Baltimore, as a convenient and useful contrivance 
in the treatment of certain kinds of fractures of the leg and 
thigh, is well known, not only on this side of the Atlantic 
but in Europe. It is especially valuable in the management 
of compound fractures, and did excellent service during the 
late war on both sides of the line. A modification of Pro- 
fessor Smith's splint, much employed by our Western con- 
freres, was devised some years ago by Dr. Hodgen,^ of St. 
Louis. An admirable splint, provided with a movable foot- 
board, and constructed upon the principle of the double in- 
clined plane, was invented by Professor N. R. Smith* early 
in his professional life, and is well adapted to cases of frac- 
ture of the leg and thigh, admitting of the suspension of the 
limb. The treatment of fractures of the lower extremity, 
in which the counter-extension is made by the weight of the 
body by raising the foot of the bedstead, originally sug- 
gested, I believe, by Dr. James L, Van Ingen, of Schenec- 
tady, is now much employed by American surgeons, and 
often answers where the more ordinary means fail. 

1 Bull. N. Y. Acad, of Med., vol. i. p. 181. 

2 Maryland and Va. Med. aud Surg. Journ., Jan. and March, 
1860. 

3 St. Louis Med. and Surg. Journ., Jan. 1864. 

* Baltimore Med. and Surg, Journ., vol. i. p. 13. 



148 SURGERY. 

In compound fractures of the leg, the bran-dressing, in- 
troduced by the late Dr. John Rhea Barton,^ of Philadel- 
phia, is an extremely valuable improvement, not only as 
afifording a comfortable lodgment for the affected limb, but 
also as a means of preventing the contact of flies, and the 
deposit and formation of larvoe, so common in hot weather 
when this precaution is neglected. The bracketted splint, 
now so much employed in the treatment of compound frac- 
tures of the lower extremity, originated, if I mistake not, 
with Dr. A. Hays, of Indiana, who found it very useful in 
cases of gunshot wounds of the leg and thigh during our war 
with Great Britain in 1812. 

One of the most valuable improvements, purely American 
in its origin, introduced into the treatment of fractures, 
especially of fractures of the lower extremity, is the use of 
adhesive plaster as a means of extension and counter-exten- 
sion, as well as of adjustment of the ends of the fragments. 
The first public notice of this method of treatment appeared 
in my work on the Diseases and Injuries of the Bones and 
Joints, published in this city in 1880. I had witnessed the 
beneficial effects of this mode of making extension in a case 
of complicated fracture of both bones of the leg in the hands 
of my first preceptor, the late Dr. Joseph K. Swift, of Easton, 
Pennsylvania, and I subsequently employed it in my own 
practice. Since that period the application of adhesive 
plaster, as a means of making extension and counter-exten- 
sion, has become generalized, and it is seldom that it is en- 
tirely dispensed with in any case of fracture of the long 
bones of the lower extremity. Upwards of twenty years 
ago, in a communication in the Philadelphia Medical Ex- 
aminer,"^ I called attention to the claims of priority for Dr. 
Swift in this mode of treatment, and at the same time stated 

» Am. Jouni. Med. Sci., May, 1835, p. 31. 
2 Nov. 1852. p. 685. 



SURGERY. 149 

that I had found in adhesive plaster an adinirable dressing 
in fractures of the clavicle, ribs, and scapula. Notwithstand- 
ing this, Dr. Sayre, of New York, is usually credited with 
its origination. 

The apparatus of the late Dr. Thomas Bond,^ of this 
city, consisting of two splints, one of peculiar construction, 
stretched along the bones of the forearm, and provided with 
a knob for the accommodation of the hollow of the hand, is 
decidedly the best and most convenient contrivance that has 
ever been invented for the successful treatment of fractures 
of the inferior extremity of the radius or radius and ulna. 
The apparatus of Dr. George Fox, of Philadelphia, for the 
treatment of fractures of the clavicle did, for a long time, 
good service both in private and hospital practice, acting as 
a most valuable substitute for the complicated contrivance 
known as Desault's dressing. Of the many modifications of 
this apparatus, no particular mention need here be made, 
the most important, perhaps, being those of E. Bartlett, 
Richard J. Levis, and F. H. Hamilton. 

The contrivances of John Rhea Barton and William Gib- 
son for the treatment of fractures of the lower jaw, long 
maintained their place in the esteem of American surgeons, 
and were greatly in advance, in point of simplicity and effici- 
ency, of those of European practitioners. Upon these con- 
trivances, the apparatus of Dr. F. H. Hamilton is a decided 
improvement. The interdental splint, as it is called, devised 
almost simultaneously by Dr. Gunning, of New York, and 
Dr. Bean,^ of Georgia, is, I believe, a purely American in- 
vention. 

Of fracture apparatus, fracture boxes, fracture beds, and 
fracture chairs, the fertile genius of American surgeons has 
furnished an abundant supply, much that is worthless, and 

' Am. Journ. Med. Sci., April, 1852, p. 566. 
2 Richmond Med. Journ., Feb. 1866. 
13* 



150 SURGERY. 

nincli also that is eminently useful. The fracture beds of 
Jenks, Daniels, B. H, Coates, Addinell Hewson, and E. 
Cutter, are especially worthy of commendation, as is also 
the fracture chair of William H. Pancoast. 

In the treatment of ununited fracture, the seton originally 
used in 1802, by Dr. Physick,^ enjoyed, for a long time, a 
world-wide reputation ; and, although it is now less exten- 
sively employed than formerly, it is still, in many cases, an 
admirable remedy, worthy of all the praise once bestowed 
upon it. The method of perforating the ends of the frag- 
ments with a peculiar instrument, introduced in 1852, by 
Dr. Daniel Brainard,^ of Chicago, may occasionally be bene- 
ficially employed. Connecting the fragments together with 
an iron screw, as practised by Professor Joseph Pancoast in 
1857, and since by him and other surgeons, is an eminently 
ingenious device, deserving of the highest commendation on 
account of its efficiency and freedom from danger, especially 
in ununited fractures of the femur and of the humerus. 
After excision of the ends of the fragments in this form of 
accident, it is sometimes expedient to unite the raw extrem- 
ities with wire, an operation originally suggested, I believe, 
by Horeau in 1805, but first successfully practised by the 
late Dr. J. Kearney Rodgers,^ of New York. Dr. Henry 
J. Bigelow,* of Boston, in 18fi7, published an account of 
eleven cases, all but one successfully treated by this method, 
great care having been taken to preserve the periosteum. 
I have myself treated a considerable number of cases in a 
similar manner. When exercise is required in the open air, 
as when the patient's health has suffered from general de- 
bility, loss of blood, or protracted confinement, or where all 

' Phila. Journ. Med. and Pliys. Sci., vol. v. p. 116. 

2 Northwestern Med. and Surg. .Journ., March, 1852, p. 409. 

3 N. Y. Med. aud Phys. Journ., vol. vi. p. 521. 
* Ununited Fractures, Boston, 18fi7. 



SURGERY. 151 

hope of effecting a cure has been abandoned, great comfort 
will be experienced from the use of the excellent apparatus 
invented by Dr. Henry H. Smith, ^ of Philadelphia, and de- 
lineated in most of our treatises on surgery. In fracture of 
the tibia, attended with great overlapping or loss of sub- 
stance, thereby rendering the limb comparatively useless, 
the fibula may occasionally be advantageously broken oppo- 
site to the original lesion, as suggested and successfully 
practised in several cases by Professor William H. Pan- 
coast. 

Children are liable to a form of injury of the osseous 
tissue, known as the green stick fracture, or as bending or 
incomplete fracture of the bones, the pieces most commonly 
affected being the ulna, radius, and clavicle. The humerus, 
femur, tibia, fibula, and ribs occasionally suffer in a similar 
manner, and even the bones of the head are not exempt 
from it. The first account of this singular lesion was from 
the pen of Professor Jurine, of Geneva, in 1810. The late. 
Dr. John Rhea Barton gave a graphic description of it, 
illustrated by the narration of a number of cases, in the A?)i- 
erican Medical Recorder for 1821 ; and since that period 
the whole subject has received important additions from 
the labours of Professor Frank H. Hamilton, who has 
thoroughly investigated it in an elaborate series of care- 
fully performed experiments upon the inferior animals, 
leaving nothing further to be desired upon this branch of 
surgical pathology. 

The reduction of Dislocations has been greatly simplified 
during the last twenty years, chiefly through the genius and 
influence of American surgeons. The pulleys, formerly so 
much in vogue, and deemed, in many cases, indispensable to 
success, have become almost obsolete instruments; and, as 
to Jarvis's adjuster,'^ hardly any one thinks of employing it. 

' Am. Journ. Med. Sci., Jan. 18-18 and .Jan. 1876. 
2 Lancet, 184(3, vol. i. 



152 SURGERY. 

These contrivances, thank fortune, have had their day. A 
new era has been inaugurated ; science and common sense 
have taken the place of awkvs'ard and dangerous mechanical 
appliances, and the whole process has been rendered so 
simple that one is astonished that the revelation was so 
long in coming. Reduction by manipulation is now the 
order of the day, not only in simple cases, but even in the 
most complicated, as well as in many of the more protracted. 
Although this method, is spoken of by Hippocrates, and 
although it occasionally succeeded in the hands of some of 
the practitioners during the last two hundred years or more, 
it remained for our countryman, Dr. William W. Reid,^ of 
Rochester, New York, by a series of admirably conducted 
dissections, experiments, and observations, to generalize the 
method, and to establish the universality of its application. 
The paper in which the results of his labours are comprised, 
was published in 1855, and earned for him a wide-spread 
reputation. Like Byron, he woke up one morning and 
found himself famous ; for he had justly earned his laurels. 
It does not in the least detract from the merits of Dr. Reid, 
when I add that he fell into error in referring the chief re- 
sistance to the reduction of dislocations to the action of the 
muscles at and around the injured joint. In many instances, 
indeed, as is proved when the muscular system is completely 
relaxed by anaesthesia, the obstacle is evidently caused by the 
resistance offered by the ligaments, especially in the ball-and- 
socket joints, as those of the hip and shoulder. In the former 
of these articulations, as was first shown by Professor Gunn,^ 
of Chicago, and Professor Moore, of Rochester, and more 
recently by Professor Henry J. Bigelow,^ of Harvard Uni- 

' Buffalo Med. Jouni., Aug. 1851, page 12), aud N. Y. Jouru. of 
Med., July, 1«55, p. 55. 

2 New York Jouru. of Med., Nov. 1853, p. 423. 

3 The Hip, Bigelow, Phila. 18(59. 



SURGERY. 153 

versity, the obstacle to restoration is largely, if not exclu- 
sively, due to the manner in which the head and neck of the 
thigh-bone are girt by the untorn portion of the capsular 
ligament. These facts are clearly stated by all these sur- 
geons, and they have been made the subject of a beautiful 
and valuable monograph by the Boston surgeon, published 
in 18(i9. Dislocations of many months' duration have, in a 
number of instances, been more or less readily reduced by 
manipulation alone. In denouncing the pulleys as a relic 
of barbarous surgery, I do not mean to deny that they may 
not occasionally be employed with advantage ; but their 
day, as a general principle, is certainly over, and we have 
no regret at parting with them. 

The practice of reducing dislocations by simple manipu- 
lation is by no means a modern expedient. Distinct mention 
of it occurs in the writings of Hippocrates and Paul of 
^gineta ; it was successfully employed in the last century 
by Turner, Anderson, and other English surgeons ; and in 
the early part of the present by Physick, of Philadelphia, 
and Nathan Smith, of New Haven. The late Mr. Morgan, 
of Guy's Hospital, London, was accustomed, it is said, for 
many years to avail himself exclusively of this method, 
asserting that the use of pulleys was wholly unnecessary. 
To Dr. Reid, however, is unquestionably due the credit of 
directing to it the attention of the profession in such a man- 
ner as to lead to its general adoption. 

Every surgeon has occasionally experienced great difiSculty 
in reducing dislocations of the thumb and fingers, especially 
of the former. Professor Dixi Crosby,^ of New Hampshire, 
aware of this fact, adopted, in 1826, what was then a novel 
method, consisting simply in pushing the luxated phalanx 
forcibly back upon the metacarpal bone, until it forms a 

' Am. Jouru. Med. Sci., April, 1853, p. 401, and Boston Med. 
and Surg. Journ., Oct. 1, 1857, p. 172. 



154 SURGERY. 

right angle with it, when, by strong pressure applied to its 
base from behind forward, it is readily carried by flexion 
into its natural position. Some European writers have 
claimed this operation for Mons. Gerdy, of Paris, but its 
original suggestion justly belongs to Dr. Crosby. The 
spatha of Dr. Richard J. Levis/ of this city, is a contriv- 
ance of great power, well adapted to the reduction of dis- 
locations of the thumb and fingers, and is a valuable im- 
provement upon the more ordinary procedures. 

In dislocations of the sterno-clavicular and acromio- 
clavicular joints great difficulty, amounting occasionally to 
impossibility, is experienced in preserving the contact of 
the articular surfaces. To meet this contingency I sug- 
gested, many years ago, the importance of connecting the 
parts with strong silver wire ; an idea first carried success- 
fully into practice by the late Dr. Cooper,^ of San Francisco, 
and soon afterwards by Dr. Hodgen, of St. Louis. 

The subject of congenital dislocations of the hip-joint was 
ably illustrated by the late Dr. Carnochan. In an exhaus- 
tive memoir, published in 1850, he gave an able account of 
the lesion, accompanied by the narration of a number of 
cases and dissections. 

Excessive suffering is occasionally experienced in old, 
irreducible luxations of the shoulder-joint from the pressure 
of the head of the bone upon the brachial plexus of nerves. 
In a case of this kind, in 1869, in a woman fifty years of 
age, under the care of Dr. Edward Warren,^ formerly of 
Baltimore, prompt and permanent relief was aflforded by the 
excision of the offending portion of bone. 

To Professor L. A. Dugas/ of Georgia, is due the credit 
of having pointed out, as early as 1856, a most valuable 

« Am. Journ. Med. Sci., Jan. 1857, p. 62. 

2 Ibid., April, 1861, p. 389. 

'^ Baltimore Med. Journ., Sept. 1871, p. 582. 

♦ Southern Med. and Surg. Journ., March, 1856, p. 131. 



SURGERY. 155 

diagnostic sign of dislocation of the shoulder-joint. It is 
simply this, that, when the head of the hunoerus is thrown 
off from the glenoid cavity of the scapula, it is impossible 
for the patient, or the surgeon, to place the fingers of the 
injured limb upon the sound shoulder while the elbow 
touches the front of the chest. 

The difficulty of effecting reduction in dislocations of the 
elbow backwards, in cases even of comparatively recent 
standing, is well known to surgeons. In several cases of 
this kind, in the hands of Dr. F. H. Hamilton^ and Dr. 
Lewis A. Sayre, the object was readily attained by the sub- 
cutaneous division of the triceps muscle ; and Dr. Water- 
man,2 of Massachusetts, and myself have been equally suc- 
cessful by the method of forcible extension of the forearm. 

In the cure of Bony Anchylosis, the world is indebted to 
American surgeons for several operations of an extremely 
ingenious character, since practised, more or less exten- 
sively, and more or less successfully in all parts of the 
world. Foremost among these operations is that of Dr. 
John Rhea Barton,^ originally performed in 1826, by cut- 
ting out a Y-shaped portion of the superior extremity of 
the femur in a sailor, aged twenty-one years, who had lost 
the use of his hip-joint from the effects of a fall on ship- 
board. Passive motion was instituted at the end of three 
weeks, and steadily maintained for four months, when the 
man had so far recovered as to be able to walk about with 
the aid merely of a cane. Eventually, however, the use of 
the artificial joint was completely lost In 1844, Dr. Gur- 
don Buck^ modified the operation of Barton by attacking 

' Hamilton, Fractures and Dislocations, ^jtli ed., p. 635, Pbila. 
1875. 

2 Bost. Med. and Surg. Journ., N. S. vol. iv., 1869. 

3 North Am. Med. and Surg. Journ., vol. iii. pp. 279, 400. 
< Am. .Journ. Med. Sci., Oct. 1845, p. 277. 



156 SURGERY. 

the affected joint itself. The case was one of anchylosis of 
the knee-joint, from which, after cutting through the skin 
and muscles, and dissecting up the flap, he sawed out a 
Y-shaped portion, extending nearly through the entire 
thickness of the femur, leaving indeed merely a little layer 
behind, w^hich was then broken, when the limb was placed 
upon a double inclined plane, in an easy posture, at a suit- 
able angle for future usefulness. An operation based essen- 
tially upon that of Barton, or, in other words, involving pre- 
cisely the same principles, was suggested by Brainard,^ of 
Chicago, and performed, in 1859, by Professor Joseph Pan- 
coast,^ the patient, a youth, making eventually, notwith- 
standing the formation of several abscesses and the occur- 
rence of great constitutional trouble, a good recovery with 
a useful limb. The operation, performed for osseous anchy- 
losis of the knee-joint, consisted in perforating the femur 
with a large gimlet, through a single opening in the skin, 
at half a dozen points, immediately above the articulation, 
and then forcibly breaking the bone. The procedure, it 
will be perceived, was a subcutaneous one. Dr. Brainard, 
in 1860, divided the femur through its condyles with a per- 
forator; and, in 1861, I severed the connection between the 
articular extremities of the knee with the aid of a narrow 
chisel.^ The operation thus performed is, I am warranted 
in declaring, perfectly free from danger, and should, in my 
opinion, founded upon the results of four cases, supersede 
every other devised for the purpose. Professor Sayre,* in 
1862, in a case of bony anchylosis of the hip-joint, removed 
a segment of the femur above the small trochanter, and thus 
established a false joint, followed by a good use of the limb. 

' Trans. Am. Med. Assoc, vol. vii. p. 557. 

2 Am. Journ. Med. Sci., April, 1868, p. 360. 

3 Ibid., Ajiril, 1868, p. 360. 

* Traus. N. Y. State Med. Soc, 1863, p. 103. 



SURGERY. 15*7 

America, if I mistake not, may claim priority in opera- 
tions for the relief of anchylosis of the lower jaw. Dr. 
Carnochan, of New York, upwards of twenty years ago, in 
a case of this kind, in addition to the division of the raas- 
seter muscle, cut out a wedge-shaped portion of the body of 
the bone, according to Dr. Barton's principle, in order to 
form an artificial joint; the operation, however, proved to 
be a failure, and he, therefore, suggested, under similar cir- 
cumstances, the removal of the entire half of the bone. In 
April, 1873, in a case of true anchylosis of the left temporo- 
raaxillary joint, in a girl seven years of age, I exsected the 
corresponding condyle of the bone, with the result of com- 
plete restoration of the movements of the jaw. The opera- 
tion, in which I was kindly assisted by Drs. Levis, Barton, 
Hearn, and others, consisted in making a curvilinear incision 
in front of the ear, and after separating the condyle from 
its connections with the surrounding structures cutting it 
away with the pliers and chisel. Hardly any blood was 
lost; and, with the exception of a slight attack of erysipelas, 
the recovery was rapid and in every respect most satisfac- 
tory. 

In the treatment of Affections of the Joints, American 
surgery stands pre-eminent. Physick, impressed with the 
great importance of complete and protracted rest in the 
management of this class of diseases, early in the present 
century, and long before the subject engaged the serious 
attention of our European brethren, availed himself of the 
employment of a splint, especially constructed for the pur- 
pose, to secure this end. He did not confine himself, as is 
generally supposed, in the use of this article, to the treat- 
ment of coxalgia, or scrofulous affections of the hip-joint, 
but insisted upon the indispensable necessity of rest in all 
maladies of the movable articulations, and also, not less 
emphatically, in the treatment of posterior curvature of the 
spine, known as Pott's disease. He was particularly suc- 
14 



158 SURGERY. 

oessful in cases of coxalgia. The splint wliicli he employed 
for securing complete rest to the affected structures was a 
curved one, constructed by Mr. Rush, of this city, a most 
skilful carver in wood ; it extended from the middle of the 
side of the chest to within a short distance of the ankle, and 
was sufficiently wide to embrace nearly one-half of the parts 
to which it was applied. Instead of forcing the limb into 
a straight position, the splint was shaped to its angularities, 
and it was not until after the inflammation had been greatly 
reduced by the treatment that this was attempted, and that 
the original splint was replaced by a new one. The appa- 
ratus was carefully padded to prevent excoriation of the 
skin, and was confined to the trunk and limbs by appro- 
priate bandages. 

The period occupied in effecting a cure varied from six 
months to two years, the average being about twelve months. 
" During all this time," says Dr. J. Randolph, who published 
in the Americcm Journal of the Medical Sciences for Feb. 
1831, a full account of Dr. Physick's method of treating 
coxalgia, "the splint should be kept steadily applied; the 
surgeon, in fact, should not remove it until some time after 
all the symptoms and appearances of the disease have sub- 
sided." When this object has been attained, the exercise 
of the limb may be gradually and cautiously resumed. The 
treatment, adds Dr. Randolph, was particularly applicable 
to the earlier stages of the malady, prior to the occurrence 
of suppuration. Strict recumbency was enjoined for a long 
time, and a gentle laxative, consisting of jalap and cream of 
tartar, administered every fev/ days. No material change 
was made in the diet, unless there was much inflammation, 
as evidenced by the hot, tender, and swollen condition of 
the parts, when — as, for example, in the case of a child six 
years of age — from four to six ounces of blood were usually 
taken by leeches as a preliminary measure. The drain from 
the bowels, established by the laxative, was considered as 



SURGERY. 159 

far more efiBcacioiis than the ordinary methods of counter- 
irritation. "Physick adapted the curved splint to the 
elbow, the knee, and the ankle, and frequently found this 
remedy to succeed when all others had failed." Unlike Sir 
B. C. Brodie and his followers, this great man looked upon 
ulceration of the articular cartilages, so common in this and 
similar diseases, as an invariable result of inflammation, and 
was thoroughly satisfied that rest was an indispensable ele- 
ment of treatment; an opinion now universally conceded by 
all enlightened practitioners. 

It is needless to say that vast changes have taken place 
in the treatment of the diseases and injuries of the joints 
since the days of Physick and his earlier contemporaries ; 
but the question of the great importance of rest, absolute 
and unconditional, stands precisely where it was placed soon 
after the commencement of the present century by the ob- 
servations and teachings of the Father of American Surgery. 
With the improvements which have been made in the treat- 
ment of these affections in later years are honourably asso- 
ciated the names of Sayre, Davis, Taylor, and many other 
American practitioners. 

To relieve the violent inflammation which occasionally 
occurs in the lower extremities, as in erysipelas, gunshot 
wounds, compound fractures, and compound dislocations, a 
very bold operation, consisting in the ligation of the femoral 
artery, was performed in 1813 by Dr. Henry M. Onder- 
donk,^ of New York. The case was one of wound of the 
knee-joint, which had resisted all the usual means of treat- 
ment, but readily yielded to the remedy in question after 
grave fears had been entertained respecting the safety of 
the limb. In 1824 the operation was repeated by David 
L. Rogers,^ also of New York, upon a man thirty years of 

' Ain. Med. and Phil. Reg., vol. iv. p. 176. 
2 N. Y. Med. and Phys. Journ., vol. ill. p. 453. 



160 SURGERY. 

age, with results equally gratifying. From this time on 
nothing more was heard of this method of treatment until 
1866, when it was revived, apparently without any know- 
ledge that it had been done before, by Professor Henry F. 
Campbell, of Georgia, then a surgeon in the Confederate 
army. In an article in the Southern Journal of the Medical 
Sciences, he called the attention of the profession to the 
subject, and adduced a number of cases, chiefly of gunshot 
injuries of the bones and joints, in which it is stated to 
have yielded highly gratifying results. The only European 
surgeon, so far as I know, by whom ligation of the femoral 
artery has been practised for this purpose, is Mr. C. F. 
Maunder, of London, his case being one of violent inflam- 
mation of the limb, consequent upon a gunshot wound of 
the knee-joint. Of the value of this procedure nothing defi- 
nite can, at present, be said, as the number of instances in 
which it has been employed is too limited to justify any 
positive opinion. One would suppose, judging from the 
results of general experience, that the usual depletory reme- 
dies, early and vigorously employed, and followed up by 
punctures, scarifications, and incisions of the affected struc- 
tures, would, in almost every case, be sufficient to arrest any 
inflammation, however intense, without a resort to a mea- 
sure, apparently, so fraught with danger as the ligation of 
the main artery of a limb. 

The first application of the trepldne for the relief of in- 
flammation and abscess of bone, or inflammation of bone 
threatening to pass into necrosis, is generally ascribed to 
Sir Benjamin C. Brodie. The credit of priority, however, 
is justly due to Professor Nathan Smith, ^ of New Haven, 
who performed the operation as early as the latter part of 
the last century. In Nov. 1838 his son, the late Dr. T. 
Morven Smith, reported, in the American Journal of the 

' Phila. Monthly Jouru. of Med., June and July, 1827. 



SURGERY. 161 

Medical Sciences, four cases, illustrative of the importance 
of the operation, in every one of which matter issued freel}' 
from the affected bone, although only a few days had elapsed 
since it was invaded by the disease. Of the nature of this 
mode of treatment in this class of affections it is impossible 
to form too high an estimate. Unfortunately it is seldom 
resorted to; or, if employed, the operation is performed too 
late to be productive of much benefit. For some valuable 
remarks upon the pathology and treatment of this affection, 
with an account of the history of the operation, the reader 
is referred to an able article by the late Professor G. C. 
Blackman, in the American Journal of the Medical Sciences, 
for October, 1869. 

Few subjects have been more closely or more thoroughly 
studied in this country than Amputations, and we accord- 
ingly find that the names of a considerable number of our 
surgeons are associated with " methods" of operating, either 
peculiar to themselves or modifications of the proceedings 
of others. Dr. John AVarren,^ a surgeon in the Revolution- 
ary Army, and the first Professor of Anatomy and Surgery 
at Harvard University, was the first in this country, as far 
as my information extends, to remove the arm at the shoulder- 
joint, the operation having been performed in 1781. Am- 
putation at this joint for gunshot injury was practised for 
the first time in 1813, by Dr. William Ingalls, of Boston. 
To Dr. Walter Brashear,* of Bardstown, Kentucky, belongs 
the honour of having led the way in amputations at the hip- 
joint. The case, which occurred in 1806, was a peculiar 
one. The thigh was at first removed in its continuity, but, 
as the bone was diseased in its entire length, it was disarti- 
culated, and the patient, a lad seventeen years old, made 
an excellent recovery. The next case, also a successful one, 

' Boston Med. aud Surg. Journ., vol. xx. p. 210. 
2 Mott's Velpeau's Surgery, edited bj Blacknian, vol. ii. p. 270. 
14* 



162 SURGERY. 

in the United States, was that of Dr. Valentine Mott,^ in 
1824. To these names may be added those of Buck, May, 
Bradbury, Van Buren, Joseph Pancoast, Paul F. Eve, S. 
D. Gross, J. Mason AVarren, G. C. Blackman, J. H. Pack- 
ard, Addinell Hewson, T. G. Morton, Whitcomb, Faunt- 
leroy, William S. Forbes, D. H. Agnew, George A. Otis, 
and Frank F. Maury. In some of these cases the disarticu- 
lation was effected secondarily, some time after amputation 
of the thigh in its continuity. Pancoast and myself each 
had two primary cases, followed by recovery. The only 
successful example of primary amputation at the hip-joint, 
performed during the late war on account of gunshot injury, 
was that of Dr. Edward Shippen," of Philadelphia. Dr. 
J. Mason Warren was the first Boston surgeon to remove 
the thigh at the hip-joint. Valuable statistics of this ampu- 
tation have been published by Dr. Stephen Smith^ and Dr. 
George C. Blackman.* The prevention of hemorrhage 
during this operation has always been a great desideratum 
with the surgeon, and happily, alike for science and humanity, 
this object was fully attained in Professor Pancoast's^ first 
case, by the compression of the abdominal aorta by means 
of a modification of Signorini's tourniquet, an ex})edient 
the credit of which was unjustly claimed by our English 
cousins for Mr. Lister, of Edinburgh. The first operation 
in which this instrument was employed was performed in 
June, 1860, at the Pennsylvania Hospital. 

Amputation at the knee-joint was originally performed in 
1581, by Fabricius Hildanus, and in this country for the 
first time, in 1824, by Professor ^S'athan Smith, "^ of New 

' Phila. Jouru. Med. and Pliys. Sci., vol. xiv. p. 101. 

2 Circular, No. 7, S. G. 0., Washington, 1867. 

3 N. Y. Journ. of Med., Sept. 1852, p. 184. 
^ Western Lancet, vol. xvii., p. 7. 

5 Am. Journ. Med. Sci., July, 1866, p. 22. 

6 Am. Med. Rev., Dec. 1825, vol. ii. p. 370. 



SURGERY. 1G3 

Haven, his patient making a prompt and thorough recovery. 
Yelpeau made an attempt to revive the operation, and with 
this view, in 1830, published an elaborate paper, comprising 
an account of a number of successful cases in commendation 
of it. In this country the procedure has been warmly lauded 
by Dr Thomas Markoe,^ of New York, and by Dr. John H. 
Brinton,^ of Philadelphia, whose efforts have been greatly 
instrumental in promoting the generalization of the opera- 
tion, by giving assurances, founded upon personal observa- 
tions, of its comparative immunity from danger, and of its 
superiority over amputation of the thigh in its continuity. 
Of 164 cases of amputation at the knee-joint, tabulated in 
1868 by Brinton, 53 were fatal, affording thus a mortality 
of about 32 percent., or from one-fourth to one-sixth less 
than in amputation of the limb above the articulation. Of 
these cases 117 occurred in the practice of American sur- 
geons The method of operation usually adopted in this 
country is that by anterior and posterior flaps. The em- 
ployment of lateral flaps has been strongly recommended by 
Stephen Smith,^ of New York, on the ground that the result- 
ing stnmp is better adapted for drainage and less liable to 
injury from the pressure of the artificial limb. A case occa- 
sionally occurs, as in gunshot and other lesions, in which as 
many as three flaps may be required, as in several instances 
in the hands of Professor Pancoast. 

Amputation of the ankle-joint was performed in this 
country for the first time in 1851 by myself with the aid 
of Professor Granville Sharp Pattison, before the medical 
class of the University of New York, during ray connection 
with that school as Professor of Surgery, in the case of a 
young girl, the subject of caries of the tarsal and of some of 
the metatarsal bones. A good recovery followed; but, 

' New York Joiirn. of Med., Jan. 1856, p. 9. 

2 Am. Jouni. Med. Sci., April, 1868, p. 305. 

3 Ibid., Jan. 1870, p. 33. 



164 SURGERY. 

owing to a return of disease, amputation of the leg was sub- 
sequently performed. The operation devised by Pirogoff, 
of Russia, a modification of that of Syme, has occasionally 
been successfully performed by our surgeons with the result 
of an excellent stump. Dr. Addinell Hewson,^ of Philadel- 
phia, has been particularly fortunate with his cases, several 
of which he has kindly afforded me an opportunity of in- 
specting. Chopart's amputation has also been repeatedly 
performed, and leaves in the main a better stump. In the 
cases in which I have had occasion to employ it, the result 
has been highly gratifying. 

Amputation at the elbow-joint, now an accredited opera- 
tion, was first performed on this side of the Atlantic in 
1812 by Dr. Mann, U. S. A.,^ during our late war with 
Great Britain. The operation leaves an excellent stump, 
and is less dangerous than amputation in the continuity of 
the arm, the same rule applying here as in amputation at 
the knee-joint in relation to the thigii. 

Synchronous amputation is occasionally demanded in se- 
vere mutilation of the extremities consequent upon gunshot, 
railway, and other injuries. Examples of this kind, often 
followed by rapid recovery, have occurred within the last 
fifteen years in the practice of a number of our surgeons, as 
Carnochan, Eve, Seller, S. W. Gross, Warren Stone, and 
John G. Koehler. The case of the latter is one of the most 
remarkable upon record, the operation involving the imme- 
diately successive removal of both legs and one arm, in a 
lad thirteen years of age, who made a speedy recovery. 

The good luck which occasionally attends upon ordinary 
amputations in the hands of a skilful and judicious surgeon 
is well exemplified in the practice of Professor Eve. In a 
paper in the second volume of the new series of the Soutkera 

1 Am. Journ. Med. Sci., July, 1864, p. 121. 

2 Med. Repertory, 1822, N. S., vol. vii. p. 17. 



SURGERY. 165 

Medical and Surgical Journal, this gentleman reports four- 
teen consecutive successful amputations of the thigh and 
leg, and fifty-one amputations in general without a single 
loss. 

Amputation above the shoulder-joint, involving the re- 
moval of the superior extremity along with the clavicle and 
scapula, was first performed in this country, in 1836, by the 
late Dr. Dixi Crosby, Professor of Surgery at Dartmouth 
College, New Hampshire. The morbid growth, belonging 
to that class of tumours then and long afterwards denomi- 
nated osteosarcomatous, measured thirty-seven inches in 
circumference at its widest part. Little blood was lost in 
the operation. The patient, a man thirty years of age, made 
a rapid recovery, but died twenty-eight raonths afterwards 
from an attack of paraplegia, due, as was conjectured, to 
malignant deposits in the lumber region of the spine. An 
abstract of this interesting case was communicated to me 
in 18t0 by the distinguished operator, and a full account of 
it was published in the New York Medical Record for No- 
vember, 1875, by his son Dr. A. B. Crosby, Professor of 
Anatomy at Bellevue Hospital Medical College. 

An operation similar to that of Dr. Crosby was performed, 
in 1837, by Dr. Reuben D. Mussey, then of Hanover, New 
Hampshire, and afterwards of Cincinnati, Ohio ; in 1838, 
by Dr. Amos Twitchell, of Keene, New Hampshire ; in 1838, 
by Dr. George McClellan, of Philadelphia; and, in 1845, 
by Dr. David Gilbert, Professor of Surgery in the Medical 
Department of Pennsylvania College, Philadelphia. In Mus- 
sey's^ case the removal of the scapula and clavicle was a 
secondary operation, performed five years after amputation 
of the arm at the shoulder-joint. In Gilbert's^ case the body 
of the scapula and the greater portion of the collar-bone 

' Am. Jouru. Med. Sci., Feb. 1838, p. 390. 
2 Ibid., Oct. 1847, p. 360. 



166 SURGERY. 

were retained. It is not positively certain that the entire 
clavicle was removed in the cases of Crosby and Twitchell ; 
in that of McCIellan a small portion was left, whereas in 
that of Mussey it was disarticulated at its junction with the 
sternum. The only instance of amputation above the 
shoulder-joint, antedating that of Professor Crosby, was one 
performed, in 1830, by Gaetani Bey, of Cairo, but this was 
a traumatic one, in which, after disarticulation at the 
shoulder-joint, the scapula was dissected out along with the 
projecting extremity of the clavicle ; a very easy task as 
compared with the removal of these structures when involved 
in an enormous morbid growth. Dr. Gurdon Buck, of New 
York, in 1864, amputated the scapula and a part of the 
collar-bone in a case in which the arm had been removed by 
a previous operation. From this brief historical sketch of 
these exploits it is evident that Dr. Crosby, who was for 
many years Professor of Surgery at Dartmouth College, and 
for a long time one of the leading surgeons of New England, 
is justly entitled to priority in an operation which reflects so 
much credit upon our country. 

In Excision of the Bones and Joints no country has a 
better record than ours. Indeed, it is in this field that many 
of our surgeons have achieved some of their most brilliant 
triumphs. Commencing with the extirpation of the clavicle, 
we find that this bone was removed by Dr. Mott,^ in 1828, 
in its entirety, on account of a sarcomatous enlargement, 
measuring four inches in diameter at its base. The opera- 
tion lasted nearly four hours, and was one of the greatest 
possible delicacy, requiring, as is apparent from the size and 
situation of the tumour, an extraordinary amount of skill 
for its successful execution. Upwards of forty vessels were 
secured. The patient made an excellent recovery, and with 
the aid of an apparatus constructed for the purpose obtained 

» Am. Journ. Med. Sci., Nov. 1828, p. 100. 



SURGERY. 167 

a good use of his arm. Excision of this bone for similar 
reasons has been executed by John C. Warren, Cooper, 
Curtis, Eve, Palmer, and others. Dr. Charles McCreary,^ 
of Kentucky, in 1813, excised the clavicle at its articula- 
tions for scrofulous caries; and similar operations have been 
performed by Wedderburn, Blackman, Fuqua, and other 
surgeons. As a brilliant and daring exploit, the case of 
Dr. Mott is without a parallel in the annals of surgery. 

The scapula has been repeatedly removed, by the sur- 
geons of this country, generally on account of sarcomatous 
or enchondroraatous disease; the principal operators having 
been Mussey, of Cincinnati, Gross, of Philadelphia, Ham- 
mer, of St. Louis, Rogers, of New York, and Schuppert, of 
New Orleans. In the cases of Hammer and of Rogers,^ the 
excision was effected at two periods; in the first after the 
lapse of a few days, in the second of a few months. 

With excision of portions of the ribs of greater or less 
length, are associated the names of a number of American 
surgeons, among whom may be especially mentioned John 
C. Warren, George McClellan, William Gibson, and William 
A.^ McDowell.^ In the latter case the sixth and seventh 
ribs were disarticulated at their connection with the verte- 
brae; the only one of the kind, I believe, on record. I have 
myself done a good deal of work in this direction. The 
sixth volume of the Philadelphia Journal of the Medical and 
Physical Sciences records a remarkable case, in which Dr. 
Milton Antony, of Georgia, alleges to have removed the 
fifth and sixth ribs, which were extensively carious, along 
with two-thirds of one of the lobes of the right lung; the 
patient surviving the operation nearly four months. 

Excision of the coccyx, performed as early as 1832, by 

' Gross' History of Kentucky Surgery, p. 180. 
2 Am. Journ. Med. Sci., Oct. 1868, p. 359. 
Am. Med. Recorder, vol. xiii., 1828, p. 113. 



168 SURGERY. 

Dr. Josiah C. Nott/ of Mobile, Alabama, on account of a 
neuralgic affection now known as coccyodynia, was a pioneer 
operation, highly creditable to the originator. The bone, 
hollowed out into a mere shell, and the seat of severe and 
intractable suffering, was disarticulated at the second joint 
and carefully detached from its ligamentous and muscular 
connections. Although the wound was slow in healing, the 
patient, a lady, twenty-five years old, eventually completely 
recovered. Since that time the operation has been repeated 
in a number of instances, always with excellent results: a 
full account of it was published by the late Sir James Y. 
Simpson, of Edinburgh, to whom has occasionally been 
erroneously awarded tiie credit of having been the first to 
suggest and to perform it. 

The only cases of excision of the head of the humerus 
claiming attention in a paper like this, are those reported 
by Professor Warren {vide p. 154), formerly of Baltimore, 
and lately in the service of the Khedive of Egypt, and of 
the late Professor Blackraan, of Cincinnati, in the former of 
which this bone was removed, in 1868, on account of the 
pressure which it produced upon the axillary plexus of 
nerves, caused by downward displacement; and in the latter, 
in which, in 1870, it was exsected for a similar reason on 
account of arthritic enlargement. Both operations were 
successful in relieving the excruciating pain, for the relief of 
which they were performed. Practically these two cases 
present great points of interest as examples for imitation in 
similar lesions. Excision of the elbow-joint, originally ex- 
ecuted by the elder Moreau, in 1794, was first performed in 
this country by Dr. John C. Warren, ^ in 1834. Of excision 
of the wrist-joint I am unable to say who led the way. Dr. 
Bobert B. Butt,^ of Virginia, exsected the lower two-thirds 

' Am. Jouru. Med. Sci., Oct. 1844, p. 544. 

2 Hodges, Excision of Joints, p. 69. 

3 Phila. Jouni. Med. and Phys. Sci., vol. x. p. 115. 



SURGERY. 169 

of the ulna in 1825; the entire bone was removed by Dr. 
Carnochan/ of New York, in 1853; by Dr. C. T. Muscroft,^ 
of Cincinnati, in 1870; and by Dr. Joseph C. Hutchison,^ 
of Brooklyn, in 1873. The entire radius was exsected by 
Caruochan* in 1854; and a few years afterwards a similar 
operation was performed by Professor Choppin, of New 
Orleans. Both these bones, with the exception of the in- 
ferior extremity of the former, were removed, in 1853, by 
Dr. Compton,^ of New Orleans. All these cases made good 
recoveries with useful limbs. The olecranon process was 
exsected by Dr. Gurdon Buck^ in 1842, on account of 
chronic hypertrophy of its substance interfering with the 
functions of the elbow-joint. 

Excision of the hip-joint, originated by Mr. Anthony 
White, of London, in 1822, was first performed in the 
United States by Professor Henry J. Bigelow," of Boston, 
in 1852. Since then it has become a very common proce- 
dure, especially for the cure of coxalgia. Professor Sayre, of 
New York, alone having executed It fifty-nine times, with 
a degree of success reflecting the highest credit upon his 
judgment as a practitioner, and upon his dexterity as an 
operator. Of these cases thirty-nine were alive at the close 
of 1875, with a good use of the corresponding limb. Exci- 
sion of the great trochanter was first performed among us by 
Professor Willard Parker. Excision of the knee and ankle- 
joints has not been often practised by our surgeons, and I 
am unable to state who is entitled to priority. A case of 
resection of the entire fibula for fibro-carlilaginous degeuera- 



'O' 



1 Am. Med. Monthly, March, 1854. 

2 Cin. Lancet and Obs., Aug. 1870, p. 449. 

3 Am. .Journ. Med. Sci., Jan. 1874, p. 96. 
* Ibid., April, 1858, p. 363. 

5 Mott and Blackman's Velpeau, vol. ii. p. 460. 

6 Am. Journ. Med Sci., April, 1843, p. 297. 

7 Ibid., July, 1852, p. 00. 
15 



170 SURGERY. 

tion of that bone was reported, in 1858, by Dr. A. R. Jack- 
son,^ now of Chicago. The calcaneum has been removed by 
Carnochan, Morrogh, Greenleaf, McGuire, and others; the 
astragalus, by Peace ; the calcaneum and astragalus, by T. 
G. Morton; the calcaneum and cuboid bone, by J. T. Brad- 
ford, of Kentucky. Professor H. J. Bigelow, in 1855, cut 
away all the tarsal bones, excepting the astragalus and cal- 
caneum, together v/ith the head of the second and third 
metatarsal bones; and, in 1874, Professor P. S. Conner,** 
of Cincinnati, resected the metatarsus, anterior tarsus, and 
portions of the astragalus and calcaneum, followed by reco- 
very with a useful foot. 

Trephining of the skull for the cure of epilepsy was 
originally performed by La Motte, and revived by Cline, of 
London, in the early part of the present century. In this 
country the operation seems to have been first performed 
by Professor Dudley, of Lexington, Kentucky, who, in 
1828, published an interesting article upon the subject in 
the first volume of the Transylvania Journal of Medicine, 
in which he detailed the particulars of five cases, of which 
three were entirely relieved, the first having occurred in 
1819. In the eleventh volume of the American Journal of 
the Medical Sciences, the same surgeon has a paper on the 
** Use of the Trephine in Epilepsy," being, as he states, his 
sixth successful case. Dr. John G. F. Holston, of Ohio, has 
reported seven cases, in one of which a cure was effected 
after twenty years of suffering. Dr. J. T. Gilmore, of 
Mobile, has had five cases, with three cures and two deaths, 
the latter having been attended with the loss of some cere- 
bral substance. A number of examples have been reported 
in which our surgeons trephined the skull and tied the carotid 
artery for the cure of this disease. In some of these cases 

1 Am. Journ. Med. Sci., Oct. 1858, p. 357. 

2 Ibid., July, 1875, p. 86. 



SURGERY. lYl 

both the coraraou carotids were secured after a variable in- 
terval. Of the utility of trephining in certain forms of epi- 
lepsy there can be no doubt ; but that the operation, how- 
ever well performed, is generally one of great danger, is 
equally true. Of four cases in my hands the result in three 
was fatal. For valuable statistical facts relative to this 
operation the reader is referred to instructive papers, by 
Dr. Stephen Smith, ^ of New York, and Dr. J. S. Billings, 
U. S. A., in the Cincinnati Lancet for June, 1861.^ 

Puncture of the head for the cure of hydrocephalus has 
been repeatedly performed by American surgeons, Physick^ 
being one of the first, if not the first, to undertake it on this 
side of the Atlantic, his case having occurred in 1801. Dr. 
L. A. Dugas,* of Georgia, has reported a case in which he 
tapped a child's head seven times, and evacuated sixty-three 
ounces of water, the patient surviving nearly four months. 
Physick was of opinion that the operation would be more 
likely to terminate favourably if it was performed without 
the aid of compression, the puncture being made very small, 
so as to allow the water to drain off very gradually. 

Dr. Amasa Trowbridge,^ of Watertown, New York, in 
1829 reported three cases of hydrorachitis successfully 
treated, one with the knife, and the others with the wire 
ligature. Mott, Nott, Sayre, and several other American 
surgeons, have been equally fortunate with excision. In 
an instance in the hands of Dr. Charles Skinner,^ of North 
Carolina, a tumour of this kind was punctured seventy times 
without any bad effects. The treatment of the late Dr. 

• New Yo'rk Journ. of Med., March, 1852, p. 230. 

2 See Am. Journ. Med. Sci., July, 1861, p. 299. 

3 Phila. .Jouru. Med. and Pliys. Sci., vol. xiii. p. 316. 

4 Am. Journ. Med. Sci., Aug. 1837, p. 536. 

5 Boston Med. and Surg. Journ., vol. i. p. 753. 

6 Am. Journ. Med. Sci., Nov. 1836, p. 109. 



172 SURGERY. 

Brainard/ of Chicago, for the cure of this affection, is well 
known; he published a number of successful cases, but, it 
must be confessed, the remedy in the practice of others has 
been, for the most part, a signal failure. 

Trephining of the vertebrae in cases of fracture and dislo- 
cation has been repeatedly performed, but in no instance 
with any permanent benefit. One of the first of these opera- 
tions iu America was that of Dr. John Rhea Barton, soon 
followed by those of Alban Goldsmith and J. K. Rodgers, 
and, more recently, by those of Blackman, Potter, Hutchison, 
Stephen Smith, and others. 

America may justly claim the honour of having led the 
way in extirpations of the upper jaw. Small portions, it is 
true, had been chipped off in the eighteenth and even in the 
seventeenth century; but the first grand and difficult opera- 
tion of the kind of which we have any knowledge, was per- 
formed in 1820, by Dr. Horatio G. Jameson,^ of Baltimore, 
who took away nearly the entire bone on one side, the roof 
of the antrum alone being left, as it was not involved in 
disease. Resection of both bones, a still greater triumph of 
surgery, was first performed in 1824, by David L. Rogers,^ 
of New York, who carried his incisions as far back as the 
anterior limits of the pterygoid processes of the sphenoid 
bone, his patient, like that of Jameson, also making a good 
recovery. Since the feasibility of these procedures was thus 
established, excision of the upper jaw has been performed in 
many hundred cases both in this country and in Europe, 
and long ago took its place among the approved operations 
in surgery. I have myself on several occasions removed 
the entire upper jaw along with considerable portions of the 
palate and sphenoid bones ; and I have been present on 

1 Am. Jouni. Med. Sci., July, 1848, p. 262. 

2 Am. Med. Rec, vol. iv. p. 222. 

8 New York Med. and Phys. Jourii., vol. iii. p. 301. 



SURGERY. 173 

several occasions in which Professor Joseph Pancoast per- 
formed a similar operation. Very considerable portions of 
the upper jawbone have been removed by some of our sur- 
geons without any external incision in the cheek, Dr. Wil- 
liam E. Horner^ having, I believe, been the first to make 
such an effort. 

In regard to excision of the lower jaw, the first case upon 
record is that of Dr. Deaderick,^ of Tennessee, who, in 1810, 
removed a section of the bone extending from near its angle 
to the centre of the chin, on account of a morbid growth, 
now generally supposed to have been an enchondroma. The 
result was a complete success, the patient surviving the 
effects of the operation many years. Unfortunately for the 
reputation of Dr. Deaderick, no account of this operation 
was published until 1823; a circumstance which for a time 
enabled other surgeons to bring forward their supposed 
claims to priority. The honour of performing the more 
bold and formidable operation of disarticulating this bone, 
and sawing it off at the chin, belongs to Valentine Mott,^ 
who achieved it in 1821. In 1828, Dr. George McClellan* 
removed all that portion of the bone immediately anterior 
to its two angles. In the New York Journal of Medicine 
for 1850, a case is reported in which Professor Ackley, of 
Cleveland, Ohio, is said to have successfully exsected the 
entire bone on account of osteosarcoma, the patient being 
in good health two years after the operation. In the Ame- 
rican Journal of the Mediccd Sciences for 1831, Dr. John 
Rhea Barton has described a case in which, on account of 
a so-called epulis, he exsected a longitudinal section of the 
lower jaw, leaving the base of the bone as a means of pre- 

« Med. Examiner, .Jan. 1850, p. 16. 

2 Am. Med. Recorder, vol. vi. p. 516. 

3 New York Med. and Phjs. Journ., vol. i. p. 385. 
■• McClellau's Surgery, p. 365. 

15* 



174 SURGERY. 

serving the countoui* of the face. Dr. James R. Wood/ of 
New York, in 1856, snccesfiilly removed the entire bone on 
account of phosphorus disease. 

For the relief of false anchylosis of the lower jaw depend- 
ing upon permanent contraction of the masseter muscle, 
caused by inordinate ptyalisra, at one time so common in 
this country, subcutaneous division of the muscles in ques- 
tion was formerly practised ; the operations for this purpose 
having been inaugurated almost simultaneously by J. W. 
Schmidt,^ of New Orleans, and Mott and Carnochan,^ of 
New York. To facilitate the restoration of the joint, and 
prevent recurrence of the contraction, Mott,^ Barton, and 
other American surgeons employed forcible dilatation by 
means of screws and levers, ingenious modifications of the 
instrument originally devised by Scultetus. 

The difficult operation of extirpating the parotid gland, 
long considered as impracticable, has been repeatedly per- 
formed in the United States, the first instance having occur- 
red in the hands of Dr. John Warren,^ of Boston, in 1804. 
The late Dr. Geo. McClellan,^ of Philadelphia, performed 
the operation altogether nearly a dozen times, and the bril- 
liant results attending his cases exerted a powerful influ- 
eiice in generalizing the procedure by inspiring surgeons 
with confidence in its feasibility. Doubtless some of the 
cases that have been reported as excisions of the gland were 
cases simply of morbid growths developed upon its surface 
or embedded in its substance ; but that most of them were 
genuine examples of extirpation is sufficiently proved by the 
high character of the respective operators. The names of 

• New York Journ. of Med., May, 1856, p. 301. 

2 Am. Journ. Med. Sci., Oct. 1842, p. 516. 

3 Mott's Velpeau by Towusend, vol. ii. p. 20, appendix. 
•J Am. Journ. Med. Sci., Nov. 1829, p. 102. 

s Surgical Observations on Tumours. Warren, p. 287. 
G McClellan's Surgery, p. 333. 



SURGERY. 175 

sncli men as Valentine Mott, George Buslie, N. R. Smith, 
William E. Horner, J. Mason Warren, Joseph Papcoast, 
H. H. Toland, and Frank H. Hamilton, not to cite others 
of great respectability, is a sufficient guarantee that they 
are capable of forming a correct estimate of what they see 
and do ; in other words, know what they are about. The 
day for denying the possibility of such an operation is long 
since passed. The procedure, however, is certainly one of 
the most difficult in surgery. 

Partial excision of the tonsils has superseded the removal 
of these organs with the double canula, practised fifty years 
ago. Most of our surgeons, if I mistake not, perform the 
operation with the volsella and probe-pointed bistoury, but 
there are some who still prefer the ingenious tonsillotome 
originally devised by Physick^ in 1828, and modified by Gib- 
son, Hosack, Fahnestock, Rogers, Cox, Mitchell, and other 
practitioners. When the enlarged tonsil is very brittle and 
unusually vascular, a condition not unfrequently followed by 
more or less copious hemorrhage, removal should, if possi- 
ble, be effected by crushing with the tonsil ecraseur, or chain 
instrument, suggested for this purpose by Dr. S. W. Gross, 
of Philadelphia. To Dr. Alexander E. Hosack, of New 
York, is usually ascribed the credit of having first called the 
attention of the profession to excision of the. tonsils with the 
knife, his -paper upon the subject having been published in 
the American Journal of the Medical Sciences for Feb. 1828. 

In carcinomatous, sarcomatous, and other tumours of the 
tonsils, extirpation of the diseased mass, when this is deemed 
proper, is usually performed through the mouth, notwith- 
standing its well known difficulties, large portions of the 
morbid growth being often left behind in consequence. In 
a case of encephaloid of the tonsils under the care, a few 
years ago, of Dr. Cheever,^ that gentleman attained his 

1 Am. Journ. Med. Sei., Feb. 1828, p. 116. 

2 First Med. and Surg. Reports, Boston City Hosp., p. 390. 



176 SURGERY. 

object by working his way through the upper and lateral 
parts of the neck. The operation, the first of the kind, if I 
mistake not, upon record, and one which reflects great credit 
upon the skill and intrepidity of the Boston surgeon, neces- 
sitated the division of the stylohyoid and styloglossal mus- 
cles, together with the separation of the fibres of the supe- 
rior constrictor of the pharynx, through the interspace of 
which the diseased mass was approached and removed. 
Twelve ligatures were applied. The wound was completely 
closed at the end of a month, uupreceded by any untoward 
occurrence. 

Numerous ingenious instruments for the extraction of 
foreign bodies from the oesophagus have been devised by 
American surgeons. The forceps invented by the late Dr. 
Thomas Bond,'^ of this city, are widely known, and have 
served as models for the various modifications now before 
the profession in this and other countries. Dr. Physick,^ 
early in his professional life, constructed a stomach tube for 
removing poisons from the stomach without being aware he 
had been anticipated by Dr. Monro, of Edinburgh. 

(Esophagotomy has been repeatedly performed. For the 
relief of organic stricture of the oesophagus it was, if I mis- 
take not, first performed in this country by the late Dr. John 
Watson, of New York. The case is reported at length in the 
American Journal of the Medical Sciences for 1844. Dr. 
David W. Cheever,^ of Boston, has performed the operation 
three times successfully for the removal of foreign bodies 
in this passage; and in 1867 it was performed with equally 
fortunate results by Dr. Alfred Hitchcock,* of Fitchburg, 
Massachusetts. 

For the removal of fibroid tumours of the nose, very 

' N. A. Med. and Surg. Journ., vol. vi. p. 278. 

2 Am. Med. Recorder, vol. x. p. 322. 

3 (Esophagotomy, Cheever, Boston, 1868. 

4 Boston Med. and Surg. Journ., July 16, 1868. 



SURGERY. 177 

severe, difficult, and bloody operations are not unfreqnently 
necessary. In a case of this kind, in which an immense 
fibroid growth filled the entire nostril and dipped far down 
into the pharynx. Dr. Mott,^ in 1841, succeeded in effecting 
complete riddance by approaching the morbid mass through 
an opening in front of the face made by dividing the nasal 
and maxillary bones The operation, one of the most ex- 
tensive aud intricate of the kind over performed, and the 
first of the kind ever done in this country, was followed by 
the most gratifying results. A case in which a large fibroid 
polyp was successfully removed from the base of the cranium 
through the hard aud soft palate by Professor Paul F. Eve, 
is recorded in the Southern Medical and Surgical Journal 
for 1836. The patient was alive and doing well twenty 
years after the operation. 

It is a singular fact that men, living in different countries, 
without intercommunication, occasionally effect simultane- 
ous, or coincident discoveries or inventions. This seems to 
have been the case in regard to staphylorraphy or palate 
suture, first methodized by Roux, of Paris, in 1819, and 
performed the following year by Dr. John C. Warren,'' of 
Boston, without any knowledge that it had previously been 
attempted in Europe. Such an occurrence can readily be 
believed when it is recollected that at the time adverted to, 
the intercourse between this country and Europe was com- 
paratively infrequent, and knowledge traversed the Atlantic 
Ocean only at long intervals. However this may be, Dr. 
Warren deserves great credit for the simplicity and effi- 
ciency of his operation. The second case of staphylorraphy 
is said to have occurred in the practice of Dr. George 
McClellan in 1823, and the third in that of Dr. Alexander 
H. Stevens, of New York, in 1826. Since that time it has 

' Am. Journ. Med. Sci., Jan. 1842, p. 257, aud Jan. 1813, p. 87. 
2 Ibid., Nov. 1828, p. 1. 



178 SURGERY. 

been performed by most of our distinguished practitioners, 
but by none so frequently as by the late Dr. J. Mason War- 
ren, of Boston, who, up to 1860, a few years prior to his 
death, had had 100 cases. It has been generally believed 
that Sir William Ferguson was the first to call attention 
to the importance of dividing the muscles in the arches of 
the palate as a means of facilitating the reunion of the edges 
of the fissure, but it is now well ascertained that this credit 
belongs to Dr. J. Mason Warren, who published an account 
of the procedure in the New England Quarterly Journal of 
Medicine and Surgery for April, 1843, thus antedating the 
paper of the British surgeon by at least eighteen months. 
Be this as it may, the importance of this suggestion has, 
judging from my own experience, been greatly exaggerated ; 
for it is only in cases attended with excessive width of gap 
that the measure is at all necessary, either as it respects the 
promotion of reunion of the borders of the opening or the 
subsequent improvement of speech. Numerous instruments, 
some of them of a very ingenious and useful character, have 
been devised for facilitating the different steps of the opera- 
tion, among others by Dr. William Gibson, of Philadelphia, 
Dr. A. E. Hosack, and Dr. George Bushe, of New York, 
and Dr. Mettauer, of Virginia. 

Dr. William -S. Forbes recently called attention to a new 
operation devised by him for the cure of " Certain Cases of 
Cleft Palate" attended with fissure of the uvula. His account 
of the procedure, illustrated by drawings and two successful 
cases, will be found in the Transactions of the College of Phy- 
sicians of Philadelphia for 1875. 

In a paper in the St. Louis Medical and Surgical Journal 
for January, 1875, Dr. Prine, of Jacksonville, Illinois, has 
thrown out certain suggestions designed to facilitate the 
performance of staphylorraphy and to insure its more per- 
fect success. The three new points which he claims are, the 
employment of the galvano-cautery, the introduction of what 



SURGERY. 179 

he styles automatic needles, and a new interpretation of the 
functions of the muscles in the pillars of the fauces, tlie 
division of which he declares to be not only useless but 
positively injurious. 

Palatoplasty, uranoplasty, or staphyloplasty is an opera- 
tion designed to close any opening, congenital or accidental, 
that may exist in the horizontal plates of the palate and 
maxillary bones. The operation was originally suggested 
and first practised by J. Mason Warren, who published an 
account of it in the Neiu England Quarterly Journal of 
3Iedicine and Surgery for 1843. Of his success a good 
idea may be formed when it is stated that of twenty-four 
cases only one failed. Speech, deglutition, and local com- 
fort were more or less improved in nearly every instance, 
although in several the loss of substance was unusually great. 

Amputation of the tongue for the relief of congenital hy- 
pertrophy of that organ was performed for the first time, in 
the United States, by Dr. Thomas Harris,^ of Philadelphia. 
Five years afterwards he repeated the operation, which, 
since that period, has been executed by different surgeons, 
most of the cases having made a good recovery. In an 
instance recently in charge of Professor N. R. Smith, ^ of 
Baltimore, the operation was successfully performed with a 
stout silk ligature. 

Extirpation of the tongue for the relief of malignant dis- 
ease has been practised, with more or less success by a num- 
ber of American surgeons, among others by Dr. J. T. Gil- 
more, of Mobile, who has reported the particulars of four 
cases. 

For the cure of salivary fistule, whether the result of injury 
or of ptyalism, an ingenious operation was devised by the 
late Professor W. E. Horner,^ of Philadelphia, consisting 

1 Am. Jouru. Med. Sci., Nov. 1830, p. 17. 

2 Ibid., April, 1875, p. 429. 

3 Smith's Surgery, Phila. 1863, vol. ii. p. 161. 



180 SURGERY. 

in making an opening with a sharp punch while the cheek 
is firmly pressed against a strong spatula held on the inside 
of the mouth, and then uniting the edges of the wound in 
the skin with several points of twisted suture, thus compel- 
ling the salivary fluid to resume its natural direction. 

Cheiloplasty and genioplasty, operations performed for 
the restoration of the lips and cheeks, are greatly indebted 
for many of their most successful applications to the genius 
and labours of Mott, Pancoast, Miitter, Hamilton, Buck, 
and others. The most remarkable results have followed the 
efforts of some of these distinguished surgeons in cases, ap- 
parently, at first sight, of the most unpromising character. 

Extirpation of the thyroid gland on account of hyper- 
trophy, cystic enlargement, or malignant disease, is very 
justly regarded as one of the most difficult and dangerous of 
operations; difficult because of the delicacy and importance 
of the structures involved, and dangerous because, first, of 
the excessive bleeding so liable to attend it, however care- 
fully executed, and, secondly, the intensity of the resulting 
inflammation of the air-passages. For these reasons it is 
seldom undertaken. The first case of this kind in this coun- 
try occurred, in 1807, in the practice of Dr. Charles Harris, 
of New York. The tumour, separated by enucleation, was 
a large one, and, although the deep-seated parts of the neck 
were extensively denuded, the patient rapidly recovered with- 
out any bad symptoms. The late Professor Blackman, of 
Cincinnati, reported one successful case; and in 1871 Dr. 
W. Warren Greene,^ of Portland, published an account of 
three examples in which he was equally fortunate. In two 
of these the tumours were of great size, the weight of one 
being estimated at five pounds. From a letter recently 
received from Dr. Greene, 1 learn that he has extirpated 
the thyroid gland altogether in seven instances, with five 

» Am. Journ. Med. Sci., Jan. 1871, p. 80. 



SURGERY. J81 

recoveries and two deaths. Dr. F. F. Maury/ of Philadel- 
phaa, has had two cases of extirpation of goiterous growths, 
one followed by recovery, the other by death. 

For the relief of hydropericardium^«roce?i^es?'s is occasion- 
ally required, and, although the operation has been repeatedly 
performed, both in this country and in Europe, it is believed 
that the first successful case was one which occurred in the 
hands of Dr. John C. Warren,^ of Boston. Yelpeau, who 
was thoroughly acquainted with the history of the operation, 
in his great work on surgery, expresses the opinion that it 
was, at the time at which he wrote, the only instance of the 
kind worthy of entire credence. The operation was per- 
formed with a small trocar and canula through the sixth 
intercostal space, the quantity of serum evacuated being 
between five and six ounces. 

Thoracentesis for the removal of accumulations of serum 
or sero-purulent fluid in the pleural cavity deserves passing 
notice here on account of the great success which has attended 
its performance in the practice of that distinguished physi- 
cian. Dr. Henry I. Bowditch, of Boston, who was the first 
on this side of the Atlantic to illustrate the great value of 
the operation. Indeed, it is not too much to say that he 
has done more by his labours and writings to diffuse a know- 
ledge of the importance of thoracentesis than all other prac- 
titioners together. In a letter with which Dr. Bowditch re- 
cently favoured me, dated November 30th, 1875, he informs 
me that he had performed the operation 325 times, the 
number of his patients being 205. Dr. Bowditch is evi- 
dently master of the field in Massachusetts ; indeed, I am 
not aware that any other practitioner, either in America or 
in Europe, can show such vast statistics. Of his success I 
am unable to speak, but it has been highly flattering, and 

• Am. Jonrn. Med. Sci., Jan. 1873, p. 281. 
2 Siuitb's Surgery, Phila. 1863, vol. ii. p. 358. 
16 



182 SURGERY. 

his regret in common with most physicians and surgeons is 
that the operation is too often employed as a dernier ressort, 
when, as most generally happens, there is no chance what- 
ever of permanent relief. The instrument used by Dr. Bow- 
ditch^ is a small exploring trocar, to which, at the sugges- 
tion of Dr. Morrill Wyman, of Cambridge, he attaches, 
when necessary, a suction apparatus, similar to the ordi- 
nary stomach pump, thus literally anticipating Dieulafoy 
by nearly a quarter of a century in the employment of what 
is now known as the aspirator. In speaking of the opera- 
tion, Dr. Bowditch remarks: "It was aspiration, pure and 
undefiled, and no mere assertion can make it different." In 
the thoracentesis of former times a much larger instrument 
was used, and the surgeon generally waited for " pointing." 
In the modern operation, which has been proved to be as 
innocuous as it is simple and satisfactory, the fluid is drawn 
off as early as possible. The instrument is easily introduced, 
without any liability of admitting air, or of leaving any fistu- 
lous opening. The place selected for the puncture, when 
practicable, is the back, in the eighth or ninth intercostal 
space, below the scapula, on a line with its inferior angle. 

To the late Dr. Horace Green, of New York, the profes- 
sion is indebted for having paved the way in this country 
in the treatment of the surgical affections of the larynx.'^ 
He was the first among us to demonstrate the possibility of 
applying nitrate of silver to this tube for the cure of inflam- 
mation, and considering that this was done years before the 
invention of the laryngoscope, he deserves not a little credit 
for his efforts to popularize this mode of medication, the 
value of which is now universally acknowledged. To Dr. 
Green also, to Dr. Gurdon Buck, and to Dr. Willard Parker, 
great credit is due for their contributions to the advance- 

1 Am. Journ. Med. Sci., Jan. 1852, p. 103, and April, 1852, p. 320. 

2 Vide Am. Med. Mouthly, April, 1854, p. 241. 



SURGERY. 183 

ment of our knowledge of morbid growths of the larynx, 
and what were considered at the time the best means of 
removing them. The instrument of Dr. Buck^ for incising 
the lips of the mouth of the larynx in oedema of the glottis 
is well known. 

The treatment of Wounds of the Intestines has long been 
an object of interest with practitioners. In this country 
the first attempt to place it in its true light was made by 
Dr. Thomas Smith, in his Inaugural Essay on " Wounds 
of the Intestines," presented for the degree of Doctor of 
Medicine in the University of Pennsylvania in 1805. This 
was followed, in 1812, by the treatise of Mr. Benjamin 
Travers, of London; and, in 1843, by my Experimental 
and Critical Inquiry into the Nature and Treatment of 
Wounds of the Intestines. This work was founded upon 
nearly seventy experiments upon dogs, instituted with a 
view of determitiing, if possible, the best mode of manage- 
ment in this particular class of lesions. Without going 
into details, it will be sufficient to state, as the legitimate 
conclusions from these researches, first, that all wounds of 
the bowels, however small, and of whatever direction, are 
almost inevitably followed by fecal effusion, unless sewed up 
before the parts are restored to the abdominal cavity ; and, 
secondly, that the simple interrupted suture, made with a 
delicate, well-waxed silk or flax ligature, placed at a dis- 
tance of a line and a half apart, and tied into a double knot, 
with the ends cut off close, answers, as a general rule, far 
better than any of the more complicated plans described in 
our works on surgery. These facts are now so well proved 
that they should be accepted as established principles of 
practice. As another deduction from these experiments, I 
ascertained that all penetrating wounds of the abdomen 
must be treated with the deep suture, passing close down 

> Am. Journ. Med. Set., Jan. 1840, p. 249. 



184 SURGERY. 

to the peritoneum, otherwise, when the patient recovers, 
hernia will be inevitable. This circumstance is now well 
known, but it was not known a third of a century ago, 
when these experiments were performed. 

In connection with this subject it may be stated that, in 
several cases of strangulated hernia, attended with gangrene 
of the intestine, occurring in the practice of American sur- 
geons, the affected portion of the tube was excised, and the 
ends stitched together with the interrupted suture, followed 
by rapid recovery. In one instance in the hands of the late 
Dr. Charles A. Luzenberg,^ of New Orleans, six inches of 
gut were thus successfully excised, the ligatures coming 
away at the end of thirty-five days. In a still more remark- 
able case, Dr. A. Brigham,^ of Utica, removed seventeen 
inches of the small intestine, and yet the patient made an 
excellent recovery. 

The radical cure of hernia has engaged much attention in 
this country, and some very ingenious modifications of dif- 
ferent methods of treatment have been suggested. Among 
our countrymen who have been particularly conspicuous in 
interesting themselves in operative procedures of this kind, 
the names of Jameson, Watson, Pancoast, Riggs, Armsby, 
and Agnew deserve special mention. 

The subcutaneous division of the stricture in strangulation 
in cases of old hernia, a hazardous operation in the hands 
of ordinary surgeons, has been practised successfully by the 
Professors Pancoast, father and son, of Philadelphia. I am 
not aware that the operation has ever been performed by any 
other practitioners in this country. 

The improvement of trusses for the retention of the bowel 
in hernia and for the radical cure of this affection has long 
been an object of deep study on the part of our surgeons, as 

^ Gross' Am. Med. Biography, p. 556. 

2 Am. Journ. Med. Sci., April, 1845, p. 355. 



SURGERY. 185 

is proved by the numerous inventions before tlie profession, 
not a few of wliich display uncommon ingenuity in the adap- 
tation of correct principles and in the accuracy of their con- 
struction. Among the very best of these contrivances, if 
indeed not the best, are the trusses devised by the late Dr. 
Heber Chase, of Philadelphia, instruments which combine, 
in an eminent degree, all the requisite qualities of such sup- 
ports. The ingenious inventor, a member of the profession, 
devoted many of the best years of his life to their improve- 
ment, and the result is that, although he long since passed 
away, they still command the confidence of our most en- 
lightened and experienced practitioners. 

To Physick^ we are indebted for the first accurate account 
of an afi'ection of the lower bowel, known as the cystic, sac- 
culated, or sacciform rectum. It was originally described 
by him in the early part of the present century, and, as far 
as my knowledge extends, no mention of it is made in any 
English work, although it is of sufficiently frequent occur- 
rence, especially in advanced life. Physick not only pointed 
out its pathology and mode of formation, but its proper 
treatment. Until the early part of the present century sur- 
geons had no correct or fixed ideas respecting the situation 
of the internal aperture in anal fistule, and the consequence 
was that many severe and even dangerous operations were 
performed that might otherwise have been avoided. Pro- 
fessor Ribes, of Paris, led the way in the investigations 
which finally cleared up this matter; a path soon afterwards 
successfully explored by the late Professor Horner,^ of Phila- 
delphia, who by a series of careful dissections, fully verified 
the observations of the French anatomist, and thus defini- 
tively settled a question which had so long agitated the 
surgical profession in different parts of the world. 

' Am. Cyclop, of Prac. Med. and Surgery, vol. ii. p. 123. 
2 Ibid., p. 82. 

16* 



186 SURGERY. 

For the cure of anal fistule, I have for the last thirty j^ears 
performed a very simple operation, consisting in the intro- 
duction of a flexible grooved director through the track into 
the bowel, drawing out the extremity of the instrument with 
the index finger previously inserted into the tube, and then, 
while the point of the instrument rests upon the opposite 
nates, dividing the overlying structures with a narrow bladed 
bistoury. I mention this operation because in Europe, and 
indeed, I believe, also, in this country, the old method of 
cutting from within outwards with the end of the finger 
hooked over the extremity of a probe-pointed bistoury in 
the rectum is the one still almost universally pursued. 

Gastrotomy has been performed several times by American 
surgeons for the removal of foreign bodies from the stomach. 
Among other cases is the remarkable one of Dr. John Bell,^ 
of Wapello, Iowa, in which a bar of lead, ten inches in 
length by upwards of six lines in diameter, weighing one 
pound, was successfully removed. Gastrotomy for the relief 
of sufifering caused by organic stricture of the oesophagus 
has, I believe, been performed but once in this country, 
namely, in 1869, the operator being Dr. Frank F. Maury,-* 
of Philadelphia. Death ensued at the end of seventeen 
hours. Dr. Samuel White,^ of Hudson, New York, early 
in the present century, performed enterotomy successfully 
for the removal of a large teaspoon, swallowed in a parox- 
ysm of delirium. 

Extirpation of the kidney, on account of destructive dis- 
ease of that organ, originally performed in 1861 by Dr. 
Cliarles L. Stoddard,* of Wisconsin, and by Feaslee in 1868, 
has since been successfully practised by Dr. J. T. Gilmore,^ 

» Am. Journ. Med. Sci., July, 1855, p. 272. 

2 Ibid., April, 1870, p. 3G5. 

3 New York Med. Rep., vol. iv., 2d Hex., 1807, p. 307. 
* Med. and Surg. Rep. 1861, vol. vii. p. 12(j. 

5 Am. Journ. Obstetrics, May, 1871. 



SURGERY. 187 

of Mobile, Alabama. The i)atient, who was pre<juant at 
the time of the operation, was delivered at the full term, 
gestation having proceeded without any untoward occur- 
rence. A resume of all the recorded cases may be found 
in the American Journal of the Medical Sciences for Janu- 
ary, 1873, page 277, and July, 1874, page 266. 

The diagnosis and treatment o^ perityphilitic abscess have 
recently been ably illustrated by the researches of Dr. Wil- 
lard Parker,^ Dr. Gurdo_n Buck, Dr. Fordyce Barker, and 
Dr. Leonard Weber,^ of New York. The operation of in- 
cising the muscular walls of the abdomen, or, in other 
words, evacuating the matter by a direct incision, was tirst 
jierformed, it would seem, in 1848, by Mr. Hancock, of 
London, and revived by Parker in 1867. By this proce- 
dure an immense amount of local and constitutional suffer- 
ing is avoided, and the part and system are placed in a 
much better condition for ultimate recovery. 

Professor Joseph Pancoast'^ is entitled to the credit of 
having performed the first successful plastic operation for 
the relief of exstrophy of the bladder. His patient was a 
young man from one of the Western States, who consulted 
him on account of this malformation in 1858. The opera- 
tion consisted in forming a covering for the exposed surface 
by means of cutaneous flaps borrowed from the immediate 
neighbourhood, which were then inserted, and approximated 
at the middle line by suitable sutures. Excellent union oc- 
curred, and the man experienced great relief from his dis- 
comfort, but died at the end of two months and a half from 
an attack of pneumonia. A similar operation was per- 
formed soon afterwards by Dr. Ayres,* of Brooklyn, with 
equally gratifj'i ng results, his patient being a young woman. 

' Med. Record, vol. ii. p. 25, and vol. xi. p. 12. 

2 New York Med. Journ., Aug. 1871, p. 142. 

3 N. A. Med.-Chir. Rev., .July, 1859. 
* Am. Med. Gaz., Feb. 1859. 



188 SURGERY. 

Since that time the operation has been repeated, in a more 
or less modified form, by surgeons in different parts of the 
world. Dr. F. F. Maury/ of this city, has performed it three 
times, twice with admirable results; it has also been success- 
fully performed by Dr. John Ashhurst,'^ by Dr. C. B. King, 
of Pittsburgh, and by Dr. Cheever and Professor Henry J. 
Bigelow,^^ of Boston-, the latter of whom, in two instances, 
modified the procedure by removing the exposed mucous 
membrane of the bladder so as to bring the cutaneous flaps 
in direct contact with the raw surface, thus fiicilitating their 
adhesion. Both cases had a fortunate termination. 

tinder this head may be briefly described an interesting 
and ingenious operation, devised by Physick, and since re- 
peatedly practised by Professor Pancoast and myself, for 
the cure of incurvation of the penis, a congenital malforma- 
tion always occurring in association with hypospadias or 
epispadias. The operation consists in cutting away a 
V-shaped section of the cavernous bodies of the organ a 
short distance behind the corona, and approximating the 
raw surfaces with several points of suture. The amount of 
structure excised should be barely sufficient to straighten 
the penis. No skin is removed ; and only a few vessels 
require ligation. The operation being completed, the organ 
is placed upon a gutta-percha splint, and covered with cold- 
water dressings, erections being prevented by the usual 
means. Nothing could be more ingenious than such a 
device, one founded upon the same principle precisely as 
the operation invented by Dr. John Rhea Barton for the 
cure of anchylosis. No mention, so far as my information 
extends, is to be found of this operation in any foreign 
works on surgery. 

' Am. Jouin. Med. Sci., July, 1871, p. 154. 

2 Ibid., p. 70. 

3 Boston Med. and Surg. Journ., Jan. 1876. 



SURGERY. 189 

As lithotomists, American surgeons are not surpassed by 
any in the world. The success of the late Dr. Benjamin 
W. Dudley, of Lexington, is, if correctly reported, without 
a parallel. It must be observed, however, that, as he did 
not keep a record of his cases, altogether, I believe, 20t, 
with a loss of only G, that there must always remain a doubt 
upon this subject. The late Dr. James Bnsh,^ who was, for 
many years, the assistant, and, if I mistake not, for a time 
a partner of Dr. Dudley, in giving an account of his opera- 
tions, stated that these results were, as nearly as could be 
ascertained, correct. But even supposing that the mortality 
was considerably higher than the above figures tend to indi- 
cate, a fact of which I have not the slightest doubt, still the 
results would be sufficiently above the ordinary standard to 
show that Dudley was a great lithotomist. In looking over 
the second edition of my treatise on the Urinary Organs, 
issued in 1854, I find that there is a table of 895 cases by 
21 different operators, including those of Dudley, with a 
mortality of 44, or 1 in 20^ ; a degree of success which, to 
say the least, may justly be styled brilliant. It will not be 
without interest to add that in 426 of these cases the instru- 
ment used was the gorget, and the knife in 424, with a mor- 
tality for the former of 1 in 23/9, and for the latter of 1 in 
19y\-. Dudley invariably employed the gorget, an instru- 
ment now entirely disused on this side of the Atlantic. 
Valentine Mott always employed the knife, and, with the 
exception of Physick and Gibson, all the Philadelphia sur- 
geons did the same. Dr. Alexander H. Stevens, Dr. N. R. 
Smith, Dr. Gurdon Buck, and several others have devised 
peculiar instruments for this operation, but whether they 
possess any superiority over the ordinary bistoury, now so 
much in use among surgeons, experience has not deter- 

1 Am. .Journ. Med. Sci., Feb. 1838, p. 535, aud April, 1846, 545. 
Trans. Am. Med. Assoc, vol. iv. p. 273. 



100 SURGERY. 

mined. The method of operation usually selected is the 
lateral, as practised and perfected by William Cheselden, 
in the early part of the last century. A few of our surgeons 
prefer the bilateral method. The suprapubic operation was 
first performed in this country by Dr. William Gibson, of 
this city. The median operation, usually but improperly 
described as Allarton's method, has yielded good success in 
the hands of some of our surgeons, as Albert G. Walter, of 
Pittsburgh, and J. L. Little, and Thomas M. Markoe, of 
Xew York. The largest calculus ever successfully extracted 
from the bladder, although not without breaking it, weighed 
twenty ounces, the operator being Dr. A. Dunlap, of Spring- 
field, Ohio, and the patient, who survived this ordeal nearly 
three years, a man sixty-six years old. The largest number 
ever removed was upwards of one thousand, varying from 
the size of a partridge shot to that of a bean, in the cele- 
brated case of Chief Justice Marshall, who was cut by 
Physick when both were at an advanced age, the illustrious 
patient making an excellent recovery.^ 

It is generally supposed that lithotomy was first per- 
formed in this country about 1760, the operator being Dr. 
John Jones, subsequently professor of surgery at Xew York, 
and after his removal to Philadelphia for a time physician 
to Washington and Franklin. The latter, as is well known, 
laboured for many years under stone in the bladder, but 
was evidently afraid to submit to the use of the knife, not- 
withstanding the severity of his suflferings. 

The most extensive collection of urinary calculi in the 
United States is in the museum of the College of Physicians 
of Philadelphia, and forms a part of the bequest of the late 
Professor Miitter. Many of the specimens, however, were 
obtained in Europe. To Professor Peter,- of Lexington. 

• Am. Joaru. Med. Sci., Feb. 1832. p. 537. 
2 Western Lancet, Nov. IS 16, p. 241. 



SURGERY. 101 

Kentucky, the profession is indebted for the most compre- 
hensive series of analyses of urinary calculi yet made in this 
country. The specimens examined by him formed a portion 
of the collection contained in the museum of Transylvania 
University, as the result of the operations of Professor 
Dudley. The paper published upon the subject by Dr. 
Peter is well worthy of an attentive perusal. The largest 
stone ever successfully removed in - this country was, as 
already stated, one which occurred in the practice of Dr. 
Dunlap, of Ohio. Professor Eve removed successfully one 
hundred and seventeen calculi from one patient, and Phy- 
sick, as above mentioned, upwards of one thousand, all of 
course very small. The lateral operation has been most 
frequently performed by B. W. Dudley, Valentine Mott, 
N. R. Smith, J. P. Mettauer, Paul F. Eve, W. T. Briggs, 
and S. D. Gross; the bilateral by R. D Mussey, P. C. 
Spencer, Willard Parker, Joseph Pancoast, and Paul F. 
Eve. Walter, Little, and Markoe have thus far been the 
principal advocates of the median method. The supra- 
pubic and rectovesical operations have been performed 
only in a few instances, and are justifiable only under 
peculiar circumstances. 

JJthotrity, more properly called lithotripsy, has never met 
with much favour on this continent, a circumstance so much 
the more surprising when it is remembered how common 
calculous diseases are in certain sections of the United 
States. The first operation of the kind was performed by 
Dr. Depeyre,^ of New York, in 1830. This was followed 
soon afterwards by the cases of Alban Goldsmith, Jacob 
Randolph, William Gibson, Joseph Pancoast, N. R. Smith, 
J. Mason Warren, P. S. Spencer, Gurdon Buck, H. J. Bige- 
low, and others. To Randolph is usually, and I believe very 
justly, conceded the credit of having been the earliest and 

• N. Y. Med. Joiiru., Feb. 1831, p. 383. 



192 SURGERY. 

most successful cultivator of lithotrity in the United States. 
lie operated a considerable number of times upon patients 
of all ages, and is said to have possessed an unwonted de- 
gree of dexterity in the use of the necessary instruments. 
Paucoast, N. R. Smith, Buck, and Bigelow, not to name 
others, also deserve honourable mention in connection with 
the subject. 

For the relief of chronic cystitis, dependent upon hyper- 
trophy of the prostate gland, one of the most painful and 
distressing of affections, attended with an almost constant 
desire to micturate, the late celebrated Mr. Guthrie, of 
London, suggested perineal lithotomy, an operation which, 
however, he never performed. This credit was reserved for 
Professor Willard Parker,^ of Ne.w York, by whom the idea 
was first practically carried out in 1846. Five years later 
he repeated it in a similar case, the patient being an old 
man, who had long suffered from the effects of this disease, 
and who, consequently, was not a favourable subject for the 
operation. He was, nevertheless, greatly benefited by it, 
but died at the end of a month, apparently from urtemic 
poisoning. Since that period the operation has occasion- 
ally been repeated by other American surgeons, among 
others by Dr. Battey, of Georgia, and Professor Powell, of 
Chicago. 

Of the great value of this operation, as a palliative 
measure, no longer any doubt can be entertained by any 
experienced or enlightened surgeon. That it will effect a 
permanent cure when the bladder has undergone serious 
structural lesion is, of course, impossible. In the milder 
cases, however, such a result may certainly be reasonably 
looked for in both sexes. The operation is less difficult 
than that for stone in the bladder, and almost the only 

I New York Jouru. of Med., July, 1851, p. 83; aud Trans. N. Y. 
State Med. Soc, 1871, p. 315. 



SURGERY. 193 

danger would probably be from hemorrhage, as the vessels 
about the prostate gland and neck of the bladder are always 
much enlarged and engorged in chronic catarrh. 

A similar operation has occasionally been performed upon 
the female, as in the cases reported by Dr. N. Bozeman,^ 
and by Professor T, G. Richardson. Yaginal cystotomy 
for the cure of this affection was originally suggested by Dr. 
J. Marion Sims, in 1858, but was, if I mistake not, first 
performed by Dr. T. A. Emmet. ^ The wound in the blad- 
der, in this operation, is kept open until complete relief is 
afforded, when, if necessary, it is artificially closed. Dr. T. 
W. Howe^ recently successfully treated an obstinate case of 
chronic cystitis by dilatation of the neck of the bladder. 
The value of vaginal cystotomy, like that of perineal cysto- 
tomy in the male, is now fully established, and much of the 
interest which the procedure has elicited is due to American 
genius and enterprise. 

The treatment of strictures of the urethra is a subject 
which has received much attention on this side of the Atlan- 
tic. Many ingenious instruments have been devised as 
guides to the bladder, and for overcoming the obstruction ; 
instruments, perhaps, not always so valuable as the claims 
set up for them by their respective authors would seem to 
indicate. The names of Yan Buren, Gouley, and Otis de- 
serve special mention in connection with this subject. In 
regard to the perineal section, or external urethrotomy, for 
the cure of tight, callous strictures attended with fistulous 
openings in the perineum and scrotum, the operation, origi- 
nally described by Desault, was well known in the United 
States, and frequently performed, before a knowledge of it 
was introduced to the notice of European surgeons by the 

1 N. Y. State Med. Soc. Trans., 1871, p. 326. 

2 Am. Practitioner, Feb. 1872, p. 65. 

3 Medical Record, vol. x. p. 550. 
IT 



194 SURGERY. 

late Professor Syme, of Edinburgh, the principal operators 
having been Physick, Stevens, Jameson, Rogers, and 
Warren. 

The fact that masturhation, when carried to great excess, 
may, in certain constitutions and states of the system, give 
rise to insanity has long been known to medical men, and 
various remedies have accordingly been suggested for its 
cure. Of the purely medical treatment this is not the place 
to speak, and of the surgical there are only two methods 
which need here be mentioned. I allude to castration and 
the excision of a portion of the deferent tubes. Of these 
two proceedings, both practised by American surgeons, the 
former has met not only with severe criticism, but pointed 
condemnation. That such an operation is, at first sight, 
well calculated to elicit such rebuke is uot surprising; I was 
myself at one time an uncompromising opponent of it, and 
it has only been after much reflection and deliberation that 
I have reached a different conclusion. Xo man who is in 
his right senses would think of employing such a remedy in 
ordinary cases ; but when the habit of onanism is so firmly 
established as completely to wreck the patient's mind, and 
all other remedies have been employed in vain, surely any 
means calculated to rescue the unfortunate sufferer from 
destruction is not only justifiable but in the highest degree 
proper. The remedy, it will be perceived, is a very differ- 
ent one from excision of the clitoris, so absurdly practised 
by Baker Brown and others, for the cure of masturbation 
in the female. By removing the testicles the surgeon strikes 
at once at the very root of the evil, and thus places the 
patient in a much better condition for the favourable action 
of other remedies and his ultimate recovery. Professor Yan 
Buren,^ of New York, in 1848, in a case of partial idiocy 

' Genito-Uriiiarj Diseases, Van Buren & Keyes, New York, 1S74, 
p. 458. 



SURGERY. 195 

consequent upon excessive onanism, had recourse to the ex- 
cision of a section of each vas deferens, as a substitute for 
castration, all other means having failed to break up the 
disgusting habit. The operation, however, proved of no 
advantage. I am not aware that this operation, which, of 
course, is eventually followed by complete atrophy of the 
testes, has been repeated either in this country or in Europe. 

The extirpation of tumours, even of the most simple kind, 
is frequently attended with much difficulty, especially in the 
hands of young and inexperienced surgeons; a difficulty 
which is often greatly enhanced when the morbid growth 
is embedded in important structures, as in the cervical, 
axillary, inguinal, femoral, and popliteal regions. At the 
present day rules for meeting these contingencies abound 
in our surgical treatises; but it was far different a third of 
a century ago, when the only great work on surgery in the 
English language was Samuel Cooper's Dictionary; a work 
of world-wide fame, reprinted in this country, and translated 
into most of the languages of Europe. It was about this 
time that Dr. Alexander H. Stevens,^ of New York, pub- 
lished his celebrated clinical lecture on the operative surgery 
of tumours, delivered at the New York Hospital, in which 
he enunciated these two golden rules as guides in all opera- 
tions of this kind: First, to cut down fairly upon the morbid 
growth before commencing its dissection; and, secondly, to 
remove the diseased mass and nothing more. Of the value 
of these suggestions every modern surgeon is fully aware, 
and it is hardly necessary to add that, as they were the 
result of a large clinical experience, they were received with 
great respect and consideration by the medical profession 
both at home and abroad. 

The huge growths, which are occasionally developed 
during the progress of elephantiasis of the skin and connec- 

' Boston Med. and Surg. Journ., vol. xxii. p. 53. 



19G SURGERY. 

tive tissue in the lower extremities, in the genital organs, 
and in other parts of the body, although uncommon in this 
country, are now and then met with, either among our own 
people, or in persons sent hither for advice and treatment 
from South America and the West Indies ; and several cases 
have occurred in which large masses of this kind seated in 
the scrotum have been removed by some of our surgeons, as 
Picton, of New Orleans, N. Bozeman and J. S. Thebaud, 
of New York, and John Neill, of Philadelphia. The weight 
in two of these cases, both successful, was, respectively, 
fifty-three and fifty-one and a half pounds. Dr. Bozeman's ' 
patient died of peritonitis nearly a fortnight after the opera- 
tion. The tumour weighed forty pounds. 

With a view of arresting the growth in elephantiasis, Dr. 
Carnochan,^ of New York, in 1851, was induced to tie the 
main artery leading to it, hoping, by cutting off its supply 
of blood, to cause the growth to shrink, or to undergo more 
or less atrophy. His case was one of elephantiasis of the 
lower extremity, for the relief of which he ligated the femoral 
artery. In another instance — one of elephantiasis of the 
head, face, ears, and neck — the same surgeon tied both the 
primitive carotid arteries after an interval of six months.^ 
Since Dr. Carnochan's first case, ligation of the femoral 
artery for the relief of elephantiasis of the lower extremity 
has been practised by Dr. Campbell, formerly of the Phila- 
delphia Hospital, Dr. Thomas G. Morton, of this city. Dr. 
Bauer, of St. Louis, Dr. McGraw, of Detroit, and several 
others. In no instance, however, I believe has a complete 
or permanent cure followed these laudable efforts; a signifi- 
cant fact not to be overlooked in estimating the true value 
of this procedure, the more especially as most of the ope- 
rators are men of acknowledged ability. In a case of ele- 

1 N. Y. Journ. Med., Sept. 1852, p. 161. 

2 Am. Journ. Med. Sci., July, 1867, p. 109. 



SURGERY. 197 

phanliasis at the Pennsylvania Hospital, under the care of 
Dr. Addinell Hewson, marked relief was afforded by that 
gentleman's so-called earth dressing, aided by the use of the 
roller. 

In excisions of the joints and jaws, and in operations 
upon the bones for the removal of sequesters, as well as in 
the extirpation of tumours, surgeons in all parts of the 
world have long been in the habit of employing what is 
called the curvilinear incision, the first application of which 
was at one time a subject of considerable controversy, 
especially between Yelpeau and Mott. In his great work 
on " Operative Surgery," the former of these distinguished 
men dwells with special emphasis upon this form of incision, 
and in a letter addressed to Dr. Mott, in the American 
translation of the work, by Dr. Townsend, he observes: 
"A point which I deem important is that which relates to 
my new processes for the extirpation of tumours, the ampu- 
tation of the jaws, and in exsections. Persuaded that you 
must perceive at a glance all the advantages to be derived 
from the curved incision, substituted for the straight, in 
the extirpation of tumours which may be removed without 
trenching upon the integuments, I will make no further re- 
marks upon the subject in addition to those you will find 
in my notice." 

In his comments upon these remarks, Professor Mott 
states that he had invariably, in all his operations for the 
removal of the lower jaw, since 1821, employed the curvi- 
linear incision, a procedure to which, he continues, his 
French confrere justly attaches such great importance. 
" His description," he further adds, "of its advantages and 
superiority over every other mode of reaching the osseous 
structures to be exsected by the saw or nippers, is so clear 
and graphic that I have nothing to add to it whereby I 
could impress upon the mind of the surgeon its decided 
preference over every other mode." It thus clearly appears- 

17* 



19S SURGERY. 

that our countryman is fairly entitled to the credit of pri- 
ority in this important matter. I may state that I employed 
the curvilinear incision in many of ray operations long 
before I became acquainted with the fact that it had been 
used by Dr. Mott, and that Dr. Joseph Pancoast and other 
Philadelphia surgeons have, on all suitable occasions, availed 
themselves of the curvilinear incision for upwards of a third 
of a century. Of its great advantages every operator is 
fully aware. 

Excision of nerves for the cure of neuralgia and other 
affections has been frequently practised by American sur- 
geons, and has, especially of late, been carried to a very great 
extent, in one case embracing the removal of a section of 
the entire brachial plexus. The superior maxillary nerve 
has been cut out beyond the ganglion of Meckel, Dr. Car- 
nochan,^ of New York, having led the way in this bold 
procedure, in which he has been followed by Pancoast, 
Blackman, W. H. Mussey, and several others. A very 
ingenious operation for exposing and exsecting the second 
and third branches of the fifth pair of nerves was devised, 
many years ago, by Professor Pancoast, and is fully described 
in the second volume of my System of Surgery, issued in 
1872. In the four cases in which it was performed, the 
cure, in all, was permanent, after years of agonizing suffer- 
ing. An instance was recently reported by Dr. J. L. 
Stewart, of Erie, Pennsylvania, in which he exsected three 
inches of the median nerve for the relief of neuralgia caused 
by a gunshot wound of the forearm inflicted six years pre- 
viously. In 1873, Dr. F. F. Maury- exsected the brachial 
plexus of nerves from an elderly man, an inmate of the 
Philadelphia Hospital, on account of the exquisite suffer- 
ing occasioned by numerous neuromatous tumours occupy- 

1 Am. Journ. Med. Sci., Jan. 1858. p. 134. 

2 Ibid., July, 1874, p. 29. 



SURGERY, 190 

ing the integ^nment of the shoulder, back, and chest. After 
the failure of all other known and approved methods of 
treatment, the brachial plexus was exposed, and a section, 
embracing four-fifths of an inch of nerve substance, re- 
moved. The patient, who gradually recovered from the 
effects of the operation, experienced great relief immedi- 
ately after it was over, the improvement lasting for a few 
months, but the neuralgia has of late been again severe. An 
operation of a similar kind, but not for the same disease, 
has been performed by Drs. Sands and Seguin, and is re- 
ported in the New York Archives of Scientijic and Practical 
Medicine for 1873. I have myself done a considerable 
share of this kind of work; and some interesting examples 
of a rather formidable character were reported by the late 
Dr. Josiah C. Nott,^ of Mobile. In a remarkable case of 
vaginal neuralgia of twelve years' duration, in the care of 
Dr. Thomas G. Morton,^ of Philadelphia, a speedy and per- 
manent cure was effected by the excision of the perineal 
nerve. The nerve was exquisitely tender on pressure, and 
rolled under the finger like a firm cord. 

Although it is not in accordance with the design of this 
paper to speak of works on surgery, I cannot forbear refer- 
ring here to two monographs, the productions of three 
American authors, inasmuch as they have a direct bearing 
upon the subject under discussion. I allude to the work of 
Dr. S. Weir Mitchell, Dr. George W. Morehouse, and Dr. 
William W. Keen, on Gunshot Wounds and other Injuries 
of Nerves; and to the admirable monograph on Injuries of 
Nerves and their Consequences, by Dr. S. Weir Mitchell, 
issued, respectively, in 1864 and 18T2. The publication of 
these productions may be considered as forming a new era 
in the history of these lesions. Up to that period the whole 

1 Bone and Nerve Sargeiy, Nott, Phila., 1866. 

2 Am. .Jouru. Med. Sci., Oct. 1873, p. 399. 



200 SURGERY. 

subject was involved in mystery, and it was only by studying 
it in the light of clinical experience that it was successfully 
unravelled. The work of Dr. Mitchell is founded upon the 
careful observation and analysis of several hundred cases of 
injuries of nerves, and upon numerous experiments per- 
formed on animals, with a view of determining the physio- 
logical questions of the influence of pressure on nerves, 
elongation, and separation. Of this treatise it is not too 
much to say that it constitutes one of the most valuable 
contributions made to the medical and surgical science of 
the present day. Ever since the date of its publication the 
lesions of nerves have been regarded from a new stand- 
point. 

As intimately connected with the condition of the nervous 
system, brief reference may here be made to another field of 
investigation, in which the labours of Dr. Mitchell have been 
conspicuously displayed. I allude to what is called snake- 
bite, a subject concerning which science had been silent 
since the days of the Abbe Fontana in the latter part of the 
last century. In 1860, Dr. Mitchell gave to the profession 
the results of three' years of work, almost unremittingly 
devoted to the object, pointing out in the clearest manner 
the nature, accidents, and incidents of venomous wounds, 
followed, the ensuing year, by a full account of their true 
treatment, up to that period little, if at all, understood. 
Although other American physicians and scientists had 
performed experiments with the poison of the rattlesnake, 
it remained for the Philadelphia philosopher to throw an 
amount of light upon the subject, which has hardly a parallel 
in any other branch of scientific investigation. I will only 
add that the researches of Dr. Mitchell have been embodied 
in a quarto volume, issued by the Smithsonian Institution, 
at Washington City, in 1861. 

Plastic surgery has received much attention in this 
country, especially during the last thirty years. With the 



SURGERY. 201 

cultivation of this branch of the healing art are associated 
the names of a number of our most distinguished operators. 
Mention may be made, more particularly, of those of Josei)h 
Pancoast, T. D. Miitter, John Watson, J. Mason Warren, 
F. H. Hamilton, Gurdon Buck, and David Prince, who have 
all rendered good service in this way. Pancoast^ is entitled 
to great credit for his rhinoplastic operations, for the suc- 
cessful performance of which he has devised a special suture 
admirably adapted to secure effective union of the flaps, and 
generally known by his name or as the plastic suture. As 
this suture is described in all our native treatises on surgery, 
it need not detain us here. European surgeons seem to be 
ignorant of its merits, if, indeed, not of its existence. The 
Indian method is the one usually adopted in this country for 
the restoration of lost or mutilated noses, and for closing 
gaps in the cheeks and lips. J. Mason Warren^ occasionally 
adopted the process of Tagliacozzi, but, instead of raising 
the skin of the arm, as in the original method, he borrowed 
the requisite amount of substance from the forearm, a short 
distance above the wrist, thus rendering the confinement of 
the limb much less irksome. Dr. Gurdon Buck has recently 
obtained some remarkable results by the sliding process in 
operations for the cure of deformities of the nose, lips, and 
cheeks. 

Dr. John Watson,' of Xevv York, in 1844, by a plastic 
operation closed a large opening in a man's forehead, caused 
by a syphilitic ulcer, this being probably the first case of 
the kind thus treated in this country. The first instance in 
which the cure of an ulcer was effected by grafting healthy 
integument upon its raw surface occurred in the practice of 

» Operative Surgery, Phila., 1844, p. 345, and Med. Ex., N. S., 
vol. vii. p. 238. 

2 Surgical Obs., with Cases, Boston, 1867. 

3 Am. Journ. Med. Sci., Oct. 1844, p. 537. 



202 SURGERY. 

Professor F. H. Hamilton, then of Buffalo, the patient 
being a man who had lost a large portion of the skin of the 
leg by the fall of a heavy stone ; the integument was bor- 
rowed from the sound limb, but was wholly inadequate to 
cover the ulcer. The graft gradually expanded centrifugally, 
and at the end of ninety days the cicatrization was complete. 
" Since the date of this observation," remarks Professor 
Hamilton, "I have repeated it many times with almost 
uniform success." A full account of this case will be found 
in the New York Journal of Medicine for 1854. Whether 
Mons. Reverdin borrowed his ideas of skin-grafting from 
the proposal of the New York surgeon, enunciated in 1841, 
in the Buffalo Medical and Surgical Journal, before he 
had an opportunity of putting it into practice, is a question 
which need not detain us here. The principle of the two 
processes is precisely alike. 

Miitter and Pancoast, as, indeed, other American sur- 
geons, have reported a number of instances in which plastic 
operations on a most extensive scale were performed for the 
relief of the unsightly and injurious contraction caused 
by the cicatrices left by burns and scalds. Much credit is 
justly due to these two gentlemen for the boldness of their 
undertakings and for the very able manner in which they 
were executed. Prior to the publication of the results of 
their cases, little attention had been bestowed upon this 
particular branch of the subject by our European brethren. 
The late Mr. Prigden Teale, of Leeds, it is believed, took 
the lead in this class of cases in England. 

Ophthalmology, as a specialty, or separate branch of sur- 
gery, took its rise in this country upwards of half a century 
ago in connection with the establishment of Eye and Ear 
luBrmarjes in nearly all the larger cities of the Union, 
conducted by men who considered themselves as peculiarly 
fitted for this kind of work. 

The New York Eye and Ear Infirmary w^as opened in 



SURGERY. 203 

1822, the Pennsylvania Eye and Ear Infirmary at Philadel- 
phia in 1822, the Massachusetts Eye and Ear Infirmary at 
Boston in 1829, and Wills Ophthalmic Hospital of Phila- 
delphia in 1834. The American Ophthalmological Society 
was instituted in 1864, and in its transactions may be found 
numerous proofs of original and valuable contributions by 
its members. Dr. E. Williams, of Cincinnati, was, if I mis- 
take not, the first physician on this continent who made 
ophthalmology an exclusive specialty, and who delivered the 
first regular course of lectures on ophthalmic medicine and 
surgery in a medical school. 

The operations performed upon the eye during the first 
half of the present century were limited almost exclusivsly 
to the cure of cataract, the formation of artificial pupil, and 
the evacuation of fluids and of foreign matter from the 
chambers of the eye. Extraction of cataract was an infre- 
quent procedure, confined to the hands of a few skilful men ; 
comminution and depression were the common operations. 
Occasionally an eye was extirpated on account of malignant 
disease, but of enucleation of the ball as now practised we 
were in total ignorance. The operation for the cure of 
strabismus was unknown. In all these and other respects 
American surgeons did neither less nor more than their 
European brethren. The invention of the ophthalmoscope 
by Helmholtz, in 1852, revolutionized the science and the 
art of ophthalmology; and, if we have had no share in the 
vast improvements incident to that invention, one of the 
grandest of the age, we have kept steady pace with the 
advances made abroad, and, perhaps, added a few things to 
the general stock of knowledge, not wholly devoid of value. 

Among the more important of these contributions may 
be mentioned the needle-knife of Dr. Isaac Hays,^ long suc- 
cessfully employed by him, as well as others, for the com- 

' Auj. Journ. Med. Sci , July, 1855, p. 81. 



204 SURGERY. 

minntion of cataract ; the use of a suture in the cornea after 
the flap extraction of cataract by Dr. Henry W. Williams/ 
of Boston; the production of cataract in frogs by the 
administration of saccharine substances, by Dr. S. Weir 
Mitchell/ of Philadelphia; the laceration of opaque cap- 
sule, by Dr. Agnew, of New York, with an instrument com- 
bining the principle of a needle and hook, his method of 
removing foreign bodies from the cornea, and, lastly, his im- 
provements in canthoplasty and the operation for divergent 
strabismus; the gymnastic treatment of asthenopia proposed 
by Dr. Dyer, of Pittsburgh ; the test cards of Dr. Green,^ 
of St. Louis, and of Dr. Pray,* of New York, for the diag- 
nosis of astigmatism; the wire loop of Dr. Levis for facili- 
tating the extraction of cataract; the improved ophthalmos- 
cope of Dr. Knapp^ and of Dr. Loring,^ of New York ; the 
operation of Dr. Knapp for the removal of tumours from 
the optic nerve without sacrificing the eye, his hook for 
extracting foreign matter from the ball,^ and, lastly, his im- 
provement of the ring forceps;^ the theory of Dr. Loring^ 
of the cause of the light streak in the vessels of the retina, 
and of the halo around the fovea; the optometer of Dr. 
Thomson,^" of Philadelphia, for the diagnosis of ametropia, 
together with his improvements in the use of cylindrical 
glasses in conical cornea, and his discovery of the connec- 
tion between astigmatism and posterior staphyloma; finally, 
we must not forget to allude, in terms of high commenda- 

1 Trans. Am. Opbtbal. Soc, 1866 aud 1867, p. 58. 

2 Am. Journ. Med. Sci., Jan. 1860, p. 106. 

3 Ibid., Jan. 1867, p. 117. 

4 Arcbiv Optbal. aud OtoL, vol. i. p. 17. 

5 Trans. Am. Opbtbal. Soc, 1873, p. 109. 

6 Am. Journ. Med. Sci., April, 1870, p. 340. 

7 Trans. Am. Opbtbal. Soc, 1873, p. 105. § Ibid. 
9 Ibid., 1870, p. 122, aud 1873, p. 87. 

'0 Am. Journ. Med. Sci., Jan. 1870, p. 76, and Oct. 1870, p. 414. 



SURGERY. 205 

tion, as the very latest American addition to ophthalmo- 
logy, to the improved ophthalmoscope of Dr. Shakespeare, 
of Philadelphia, published in the American Journal of the 
Medical Sciences for Jan. 18Y6, a contrivance, apparently, 
admirably adapted to physiological experiments as well as 
to the diagnosis of diseases of the eye. 

In the American appendix to Cooper's Dictionary of 
Surgery, issued in 1842, appears the curious statement by 
the editor. Dr. David Meredith Reese, that the straight 
muscles of the eye were divided by Professor William Gib- 
son, of Philadelphia, for the cure of strabismus several years 
before the operation was performed by Dieffenbach, of Berlin. 
The result, however, it would seem, was not satisfactory, and 
the operation was finally, at the earnest solicitation of Dr. 
Physick, abandoned. After a patient research, I am unable 
to find any allusion to this operation in the writings of the 
Philadelphia surgeon ; and the assertion of Dr. Reese ap- 
pears to be based wholly upon a statement of the late Dr. 
Alexander H. Hosack, of Xew York, who, it is alleged, 
heard Dr. Gibson refer to the subject in his lectures in the 
University of Pennsylvania. In this country the operation 
of Dieffenbach was first performed by Dr. Willard Parker, 
and soon afterwards by Dr. Isaac Hays, of Philadelphia, 
Dr. Detmold, of Xew York, Dr. Golding, of Arkansas, and 
by myself, then a resident of Kentucky. 

Although Aural surgery had no existence in this country 
as a scientific study until a quarter of a century ago, it may 
confidently be affirmed that it is nowhere cultivated with 
more ardor, or practised with more success, than it is at 
present on this side of the Atlantic. If we have not made 
any advances or discoveries, our knowledge of the pathology, 
diagnosis, and treatment of the diseases and injuries of the 
ear is of the highest order, fully on a level, in every respect, 
with our knowledge of the other branches of the healing art. 

Among the earliest and most valuable contributions to 
18 



206 SURGERY. 

otology may be mentioned the researches of Dr. Edward H. 
Clarke, late Professor of Materia Medica at Harvard Uni- 
versity, " On the Causes, Effects, and Treatment of Perfora- 
tion of the Merabrana Tympani," published in the American 
Journal of the Medical Sciences for January, 1858. This 
paper was followed in the same year by that of Dr. Laurence 
Turnbull, in the Philadelphia Medical and Surgical Re- 
porter^ "On the Treatment of Otorrhoea considered as a 
sequel of Scarlatina." The same writer, in 1862, published 
a valuable memoir on "Otitis Interna," illustrated by three 
cases treated by perforation of the mastoid cells, the first 
operations, it is believed, of the kind performed in this 
country. 

Among the more recent contributions to the subject is 
that of Dr. Edward H. Clarke, of Boston, on the Nature 
and Treatment of Polypus of the Ear ; of Dr. Charles H. 
Burnett, of Philadelphia, on the Mechanism of the Ossicles 
of hearing and the Membrane of the Round Window; of 
Dr. Hermann Knapp, of New York, on the Inflammations 
of the Internal Ear; of Dr. J. Green, of St. Louis, on the 
Action of Condensed Air on the Eustachian Tube; of Dr. 
J. O. Green, of Boston, on Otorrhcea ; of Dr. Seeley, of 
Cincinnati, on Aural Polypus and its Treatment ; of Dr. 
Rumbold, of St Louis, on the Functions of the Eustachian 
Tube in relation of the renewal and density of the air in the 
Tympanic Cavity ; and of Dr. A. H. Buck, of New York, 
on the Mechanism of Hearing. For further information as 
to what has been done in recent years in this department of 
surgery, I must refer the reader to the Transactions of the 
American Otological Society. 

I cannot omit here the insertion of a brief account of the 
ward carriage^ as it is termed, of Dr. Thomas G. Morton, 
of Philadelphia, devised a few years ago, and employed with 
such signal benefit at the Pennsylvania Hospital, for which 



SURGERY. 207 

it was originally constructed.^ Why it is not in general use 
in all such institutions is a question that might well be 
asked. Its arrangements are so perfect, and its conveni- 
ences so great, that it is only surprising it was not thought 
of long ago. The appliances for cleansing wounds and 
ulcers are so complete that there can no longer be any excuse 
for an impure or infectious condition of the atmosphere in 
the wards of any hospital in which the carriage is employed. 

The same ingenious surgeon, in 1872, invented an admi- 
rable hospital carriage and bed-elevator for the transfer of 
surgical and medical cases, from one ward to another, or to 
and from the amphitheatre for operation and clinical in- 
struction. By this contrivance the inconveniences attend- 
ant upon the ordinary procedure of carrying the patient 
about upon his bed, a mode of conveyance often accom- 
panied with great jarring and discomfort, are entirely 
obviated. The apparatus consists of a double truck, the 
upper one of which is elevated by a series of cams, running 
upon a narrow iron track, and capable of being raised and 
depressed at pleasure by means of a chain worked by a 
crank. It is six feet and five inches in length by two feet 
and nearly a half in width, is constructed of oak, and is 
moved by four wheels supported by steel pins. A descrip- 
tion of the apparatus, accompanied by a wood-cut, may be 
found in the American Journal of the Medical Sciences for 
July, 1874. 

To write the history of a century of American Surgery 
without a recognition of the services rendered by our Army 
Surgeons, would be an unjustifiable omission. My only 
regret" is that my limited space does not permit me to enter 
more into particulars. 

Of the amount of service contributed during the late war 
by the medical profession a tolerably correct estimate may 

* Am. Journ. Med. Sci., Jan. 1867, p. 135. 



208 SURGERY. 

be formed when it is stated that 11,608 surgeons and assist- 
ant surgeons were on active duty either in the field, in the 
camp, or in the hospital. Of this number, 9 were killed by 
accident, and 32 in battle, by guerillas, or by partisans; 83, 
of whom 10 died, were wounded in action; 4 died in prison, 
7 of yellow fever, 3 of cholera, and 271 of various diseases, 
mostly incident to military life ; presenting thus an aggre- 
gate of 409 names. The amount of labour performed by 
the medical staif during the war may be faintly guessed 
when it is stated that 157,423 cases of wounds and dis- 
eases occurring among the white troops were treated in 
general hospitals alone, exclusive of the vast numbers that 
were attended in regimental and post hospitals. 

Surgeon-General Barnes, at the close of his annual report 
for 1865, in speaking of the character of the medical staff 
of the army, says : "I desire to bear testimony to the 
ability, courage, and zeal manifested throughout the war 
by the officers of the Medical Department under all circum- 
stances, and upon all occasions. With hardly an exception 
they have been actuated by the highest motives of national 
and professional pride, and the numbers who have been 
killed and wounded bear most honourable testimony to 
their devotion to duty on the field of battle." 

How far the services of these faithful and devoted men 
were instrumental in bringing the war to a favourable issue, 
and in rescuing the lives of wounded and diseased soldiers 
by the timely and judicious interposition of their scientific 
knowledge and skill, is, of course, merely a matter of con- 
jecture. That they were of vast importance no intelligent 
man will doubt ; and it is not too much to say that the 
country owes the Medical Staff a great and lasting debt of 
gratitude. 

Most of the hospitals erected during the war were con- 
structed on the pavilion principle, and were supplied with 
every possible accommodation, comfort, and convenience. 



SURGERY. 209 

It seemed, indeed, as if the Government bad been deter- 
mined, through its medical staff, to rob injury, disease, and 
surgical operations of their terror, such was the palatial 
character of many of these establishments. Of these hos- 
pitals u*pwards of two hundred were still in existence on 
the 1st of January, 1865. " The hospital transport system 
included four first-class sea-going steamers, equipped with 
stores and supplies for five thousand beds, besides a large 
number of river hospital boats, hospital railway trains, am- 
bulance, etc." 

The Army Medical Museum at Washington, initiated by 
Surgeon-General Hammond, and perfected by Surgeon- 
General Barnes and his medical staff, under the auspices of 
the Government, is confessedly the noblest institution of 
the kind in the world. In 1873 it contained upwards of 
fifteen thousand catalogued specimens, comprising objects 
in surgery, medicine, anatomy, microscopy, and compara- 
tive anatomy, plaster casts, drawings, crania of Indians, 
skeletons and crania of animals, birds, reptiles and fishes, 
and a complete collection of models of ambulances, litters, 
and other appliances for the transportation of the sick and 
wounded, artificial limbs, and photographs illustrative of 
surgical operations ; in short, everything that can impart 
completeness to such an establishment. 

In the same edifice is the Library of the Surgeon- GeneraPs 
Office, embracing 38,000 volumes, and 40,000 pamphlets, 
making the total number of titles nearly 70,000. About 
2000 of the works are of a non-professional character, illus- 
trative of the history of the late war, meteorology, physics, 
and other subjects. The library is especially rich in its col- 
lection of American medical periodicals. Much of the suc- 
cess which has attended the establishment of this library — 
certainly one of the largest and finest of the kind in the 
world — is justly due to the industry, zeal, and judgment of 
Assistant-Surgeon John S. Billings, who, amidst other ardu- 

18* 



210 SURGERY. 

ous duties, has devoted much of his time to the enterprise, 
and has, in addition, found leisure to prepare an admirable 
catalogue of the authors of the books, with an alphabetical 
index of subjects, thus greatly facilitating the labour of re- 
ference on the part of those who desire to consult" the col- 
lection. 

To Surgeon-General Barnes and to two of his assistants, 
Dr. George A. Otis and Dr. Joseph J. Woodward, TJ. S. 
Army, the country is indebted for their unceasing efforts 
to build up a great Army Medical Museum, and for the 
vast labour, talent, learning, judgment, and enterprise which 
they have displayed in publishing the surgical and medical 
memoirs of the late war; w^orks which, when completed, will 
reflect imperishable lustre upon the medical staff of the army, 
and upon our national medical literature. Dr. Billings, too, 
deserves honourable mention, in connection with the Sur- 
geon-General's Bureau, for the ability which marks his re- 
ports upon hygiene of the army, barracks, hospitals, and 
other subjects. 

Statistics, illustrative of the results of surgical operations, 
diseases and accidents, are, as is well known, often very 
troublesome and laborious undertakings, especially when 
attempted upon a large scale. Of this kind of work, un- 
known a third of a century ago, a very considerable amount 
has been done in this country, and, for the most part, done 
well. Among the more important and laborious of these 
contributions may be mentioned those of George W. Norris,^ 
Stephen Smith,^ Willard Parker,^ and Thomas G. Morton^ 
on the ligation of arteries for the cure of aneurism, the sup- 
pression of hemorrhage, and the arrest of morbid growths ; 

1 Am. Journ. Med. Sci., N. S., vols, x., xili., xiv. 

2 New York Med. Journ., Sept. 1852, p. 184, and Jan. 1853, p. 9. 

3 Ibid., Nov. 1852, p. 307. 

^ Peuna. Hosp. Rep., vol. 1. 1868. 



SURGERY. 211 

of S. W. Gross/ on the treatment of aneurism by digital 
compression ; of George Hayvvard," George W. Norris,^ 
and James R. Chadwick'^ on amputations in general ; of 
Stephen Smith, ^ George C. Blackman,*^ and Thomas G. 
Morton^ on amputations of the hip-joint ; of John H. 
Brinton on amputations of the knee-joint;^ of George W. 
Norris, on ununited fractures^ and compound fractures ;^° 
of Blatchford, Spoor, and J, L. Smith on hydrophobia; of 
Lewis A. Sayre,^^ Chas. K. Winne,^^ and John Ashhurst^^ 
on excision of the hip-joint ; of Stephen Rogers^^ on exci- 
sion of the scapula ; of Richard M. Hodges,^^ in an admira- 
able monograph, on excisions in general; of Frank H. 
Hamilton^^ on deformities after fractures ; of John S. Bil- 
lings^^ on trephining in epilepsy; of S. D. Gross on foreign 
bodies in the air-passages;^^ of Gurdon Buck'^ on laryngeal 
tumours ; of J. Mason Warren and Frank H. Hamilton on 
the results of surgical operations in malignant diseases ; of 
S. W. Gross on the treatment of compression of the brain 

1 North Amer. Med.-Chir. Rev. 1859. 

2 Am. .Journ. Med. Sci., N. S., vol. i. 

3 Ibid., vol. xxii., and N. S , vol. 1. 

4 Boston Med. and Surg. Journ., 1872, vol. ix., appendix. 

5 N. Y. Jouru. Med., N. S., vol. ix. 

6 Westeru Lancet, vol. xviii. p. 7. 

' Am. Journ. Med. Sci., July, 1866. 

8 Ibid., April, 1868, p. 305. 

9 Ibid., Jau. 1842, p. 13. 

'0 Contributions to Practical Surgery, Norris, Phila., 1873. 
" Trans. Am. Med. Assoc, vol. xiii. p. 469. 
12 Am. Journ. Med. Sci., July, 1861, p. 26. 
'3 Penna. Hosp. Rep., vol. ii. p. 143. 

14 Am. Journ. Med. Sci., Oct. 1868, p. 359. 

15 Boston, 1861. 

16 Trans. Am. Med. Assoc. 1855-56-57. 

17 Am. Journ. Med. Sci., July, 1861, p. 299. 

18 Phila., 1854. 

19 Trans. Am. Med. Assoc, vol. vi, 1853, p. 507. 



212 SURGERY. 

as met with in army practice;^ of George A. Otis and S. W. 
Gross on amputations and excisions necessitated by gunshot 
wounds;- of John Ashhurst on injuries of the spine ;'' of S. 
W. Gross on ligation of the veins ;* of Thomas G. Morton 
on amputations,^ and on lithotomy and lithotrity at the 
Pennsylvania Hospital f of S. W. Gross on synostosis of 
the knee-joint;' of William Hunt^on fractures of the larynx; 
of Thomas H. Andrews^ on penetrating wounds of the skull ; 
of R. 0. Cowling on tetanus; of J. Soils Cohen^° on croup 
in its relations to tracheotomy ; of G. A. Yan Wagenen on 
fractures treated at Bellevue Hospital with plaster of Paris 
apparatus; and of Charles W. Dulles^^ on suprapubic litho- 
tomy. 

Finally, let it not be supposed from what precedes that 
the American surgeon is a mere operator ; if he ranks high 
in this particular, be ranks high also as a therapeutist. 
Nowhere, it may safely be asserted, are the great principles 
of surgery better taught, or better understood, than they are 
in this country. As a general practitioner, skilled in diag- 
nosis, and in the art of prescribing, it is no presumption to 
affirm that he has no superior. If, as a body, we are deficient 
in any particular, it is in the more refined and subtile por- 
tions of our studies ; studies which, after all, are of no 
essential practical importance, and which, it is not too much 
to say, will in due time receive their just proportions. 

1 Am. Jouni. Med. Sci., July, 1873. 

2 Ibid., Oct. 1867, p. 423. 

3 Injuries of the Spine, Phil. 1867. 

4 Am. Journ. Med. Sci., Jan. and April, 1867. 

5 Ibid., Oct. 1870. 

6 Penna. Hosp. Rep., vol. ii. 1869. 

7 Am. Journ. Med. 3ci., April, 1868. 

8 Ibid., April, 1866. 

9 Penna. Hosp. Rep., vol. i. p. 281. 

1° Trans. Med. Soc. of Pennsylvania, 1874. 
*' Am. Journ. Med. Sci., July, 1875, p. 39. 



SURGERY. 213 

As a proof of what has been here stated, it is only neces- 
sary to refer to a few well-known facts. Thus, the treat- 
ment of wounds and injuries has been greatly simplified 
during the last fifty years. The importance of rest and of 
the prevention of pain in these and other lesions is univer- 
sally recognized. The adhesive process is aimed at after 
all operations, whether small or great. None but the most 
simple dressings are employed. Little, if any faith, is placed 
by any enlightened or experienced surgeon on this side of 
the Atlantic in the so-called carbolic acid treatment of Pro- 
fessor Lister, apart from the care which is taken in applying 
the dressing, or, what is the same thing, in clearing away 
clots and excluding air from the wound ; — an object as 
readily attained by the "earth dressing" of Dr. Addinell 
Hewson,^ of Philadelphia, and by the oil dressing — com- 
posed of a thin layer of cotton or patent lint, wet with 
olive-oil — which I have myself employed for many years, 
with signal benefit, in nearly all cases of woujids under my 
charge, whether the result of accident or design. Such a 
covering, at once light and simple, answers every purpose, 
even in the largest wounds, excluding the ingress of foreign 
matter, and keeping the tissues moist and comfortable. The 
treatment of fractures with the aid of adhesive plaster and 
other appliances has received, as w^e have seen, some of its 
most valuable improvements in this country. No more 
beautiful or delicate instruments are manufactured than in 
Philadelphia, New York, Boston, and other large cities of 
the Union. The American artificial limb - is celebrated 
everywhere for its elegance, lightness, and durability. Our 
adhesive plaster was formerly, if, indeed, it is not still, 
unequalled in excellence. Collodion, as a surgical dressing, 
owes its origin to an American physican, Dr. J. P. May- 
nard, of Boston. The wire suture was introduced into 

• Earth as a Topical Application in Surgery, Phila., 1872. 



214 SURGERY. 

regular practice by Dr. J. Marion Sims ; and Professor 
Joseph Pancoast, many years ago, invented an ingenious 
suture, of peculiar construction, admirably adapted to pro- 
mote the success of rhinoplastic and other plastic operations. 
The use of compressed sponge, so valuable in the treatment 
of many surgical affections, is mainly of American origin, 
largely due to the labors of the late Dr. J. P. Bachelder, of 
New York. The pathology and treatment of inflammation 
are much better understood ; a much more rational system 
of dietetics prevails ; inordinate depletion, in the form of 
heroic bleeding and purging, has ceased to be the order of 
the day ; the influence of Nature in the cure of disease is 
better appreciated ; and sanitary science has pointed out 
new paths of inquiry and of investigation, all tending to 
prevent suffering and to prolong life. Two most valuable 
remedies, of native origin — gelseminura and veratrum viride 
— have been added to the surgeon's pharmacopoeia, and 
hold the same exalted rank in this country as depressants in 
the treatment of inflammation, neuralgia, and rheumatism, 
that aconite enjoys in Great Britain and on the Continent of 
Europe. 

Conservative surgery is nowhere more thoroughly appre- 
ciated than it is in this country. Taking its rise with Phy- 
sick, who was a great advocate of rest in the treatment of 
local diseases, and who scrupulously refrained from the em- 
ployment of the knife whenever it was possible, it has always 
formed a prominent trait in the conduct of every enlightened 
American practitioner. Comparatively few knivesmen, pro- 
perly so called, exist among us, and it is worthy of note 
that their career is usually as shortlived as it is inglorious. 

It will thus be seen that during the hundred years which 
have just elapsed the medical profession has kept steady 
pace with the general progress of the arts and sciences on 
this continent; and not the least gratifying circumstance 
connected with it is the knowledge that it occupies a posi- 



SURGERY. 215 

tion in the social circle not accorded to it in any other part 
of the world, Great Britain, perhaps, excepted. The cul- 
tured and refined American physician is a prince among 
men. Let us be grateful for what we are and for what we 
have done ; grateful that the past has such a splendid re- 
cord — that it has left such distinct footprints upon the sands 
of Time — and that the future is so full of bright promises. 
The surgeons who are now rapidly passing away — those 
links between the past and the present — who hdve so long 
borne the heat and burden of the day — are not afraid to 
entrust to their younger brethren the sacred duty of carry- 
ing on the work which they have so zealously laboured to 
advance and improve. They feel assured that the honour, 
the dignity, and the glory of American surgery will be safe 
in their keeping, and that the century closing with the year 
1976 will open for medicine one of the brightest pages in 
the history of human progress. 



OBSTETRICS AND GYNECOLOGY. 



BY 
T. GAILLARD THOMAS, M.D, 

PROFESSOR OF OBSTETRICS AND DISEASES OF WOVIK.N AND CHILDREN, IN THE 
COLLEGE OF PHYSICIANS AND SCKGEONS, NEW YORK. 



19 



OBSTETRICS AND GYNAECOLOGY.' 



The progress of philosophy, theology, politics, and sci- 
ence has never, in the history of the world, been marked by 
steady, monotonous, and gradual advancement. For long 
periods it has appeared to be so, but now and then, once in 
a century perhaps, each of these departments has felt the 
impetus imparted to it by the influence of some rare and 
stupendous genius, which, in a brief period, has effected 
more than years of patient toil had before accomplished. 
Some man, towering in intellect above his fellows, ordained 
by nature to lead into unexplored regions, and to dominate 
new fields of thought, has here and there made his appear- 
ance, and marked his epoch as an era. In more modern 
times philosophy has felt the influence of Bacon, theology 
that of Luther, science that of Newton, and politics that of 
Napoleon. 

So has it been with the progress of each of the depart- 
ments of the healing art. Surgery, medicine, chemistry, 
anatomy, physiology, and the collateral science of botany, 
has each in turn, since the revival of learning, felt the pro- 
pulsive influence of Pare, Boerhaave, Berzelius, Morgagni, 
Harvey, and Linnaeus. 

Such an impetus was given to obstetrics late in the 
eighteenth century. Until that time this department was 

' The author desires to acknowledge his obligations to Dr. S. 
Beach Jones, Jr., for valuable assistance in the preparation of this 
report. 



220 OBSTETRICS AND GYNECOLOGY. 

cliiefly allotted to women, and the few male practitioners 
who devoted themselves to it occupied a lower professional 
position than those engaged in medicine and surgery. He 
who was to establish the dignity of obstetrics, to elevate it 
to the position of a science, and to open the way to its rapid 
progress, appeared in the person of William Hunter, whose 
work upon the gravid uterus was published in lt14. It is 
true that the writings of Smellie and Levret, great contri- 
butions to obstetrics as an art, preceded it; but it is equally 
true that Plunter laid the corner-stone of the science in 
giving to the })rofession a work which may be said to have 
been to obstetrics what that of Euclid was to mathematics. 
It was the forerunner of the subsequent eminently valuable 
labours of Naegle, and the inspiration of those of Denraan 
and his school. 

Two years before the foundation of this republic the new 
era of modern obstetrics was established, which has now 
lasted for a century. Its influence, immediately and de- 
cidedly felt in Europe, gave little evidence of its existence 
here, however, for the next quarter of a century, probably, 
in great part, for the following reasons. Its inauguration 
found on this continent an infant nation engaged in a 
struggle for independence with the formidable power of 
Great Britain, which taxed every resource for the following 
seven years : sparsely settled, without financial resources, 
and unprovided with the nmterials for sustaining a lengthy 
war, it became necessary for self-protection that the private 
resources, the individual efforts, the undivided energies of 
its people should be concentrated upon one single, sacred 
object. From this it resulted that until the year lt88 
attention was entirely abstracted from the pursuits of 
peace — agriculture, manufacture, science, art, were all ne- 
glected. 

The establishment of peace found the country entirely 
unprepared at once to resume those pursuits to which it 



OBSTETRICS AND GYNECOLOGY. 221 

had so long been a stranger. Tlie people were impover- 
ished, the land was unproductive, the credit of the country 
was not yet estaljlished, and its exchequer was empty. The 
immediate material wajits of the inhabitants claimed their 
almost undivided attention, and it is not a matter of sur- 
prise that for some time we find few records of national or 
private efforts put forth in behalf of science in this field or 
in any other. As an art, practised chiefly by midwives, ob- 
stetrics was a vigorous plant, deep-rooted and strong ; as a 
science, a delicate shoot, which feebly struggled with ad- 
verse circumstances for life; while the very seed of the sister 
branch of gynaecology may be said to have been unsowed. 
In spite of the prejudices of the community, at an early 
period even in colonial times a very small number of physi- 
cians, recognizing the claims of obstetrics, devoted them- 
selves to its practice. In 1753, according to Bartlett/ Dr. 
James Lloyd, a pupil of Smellie and Hunter, settled in 
Boston, and in the following year systematically began the 
practice of midwifery. He was the first practitioner so de- 
voting himself of whom records can be found. In 1762 the 
same course was pursued by Dr. William Shippen, Jr., of 
Philadelphia; and these two pioneers in obstetric science 
began the great work here which Smellie, Hunter, and 
others were striving for abroad, of placing this important 
branch upon a level with the sister departments of medicine 
and surgery. The success of their efforts may be judged 
by the facts that in 1762 Dr. Shippen delivered a course 
upon obstetrics; that in 1767 Dr. J. V. B. Tennant was 
appointed to a si)ecial chair on this subject in New York; 
and that, thus introduced as a distinct department into the 
curriculum, the subject has to the present day been recog- 
nized as one of paramount importance and dignity. 

I Med. Communication and Dissertations of Mass. Med. Soc, 
vol. ii. p. 235. 

19* 



222 OBSTETRICS AND GYNAECOLOGY. 

During this period essays were written by Orne, Osg-ood, 
and Holyoke^ upon pudendal hematocele, the Sigaultian 
operation, rupture of the uterus, retroversion of the gravid 
uterus, extra-uterine pregnancy, and descriptive of cases in 
practice, evidencing an effort in the right direction. 

In 1T9P the operation of gastrotomy for removal of an 
extra-uterine foetus was successfully performed by William 
Baynham upon the wife of a Virginia planter. The same 
gentleman^ operated with similar success upon a negro slave 
in 1799. Before Baynham's first case the operation had 
been only once performed in this country, namely, in colo- 
nial times, by John Bard, of New York, in 1759.* Subse- 
quently it was repeated by Wisharl^ and Alex. H. Stevens.^ 

The dawn of the nineteenth century found the United 
States ripe for progress and advancement, and while it was 
yet young the lamp of medical science began to burn with 
a brightness which it had not shown before, and which 
promised well for the future. We will not stop to inquire 
whether this improvement in progress was due to the fact 
that a nation, fatigued, exhausted, and impoverished by a 
severe confiict, had now had time for recuperation; or 
whether, in the language of the learned Beck," this was due 
to the "influence which our peculiar form of government 
exerts over the character and progress of science." Let the 
sequel of this sketch prove, too, whether there be any truth 

' Outline History of Gynaecology in New England, by H. R. 
Storer. 

2 N. Y. Med. and Pliilos. Journ., Jan. 1809, vol. i. p. IGl. 

3 Ibid., Jan. 1809, vol. i. p. 1G5. 

4 Parry on Extra-Uterine Pregnancy, p. 224. 

5 Phil. Joaru. of Med. and Pliys. Science, 1825, N. S., vol. i. p. 
129. 

6 N. Y. Jonrn. Med., May, 1846, p. 341. 

7 Historical Sketch of the State of Medicine in the American 
Colonies. 



OBSTETRICS AND GYNECOLOGY. 223 

in his assertion tliat "it is unquestionably true that our 
medicine participates largely of that si)irit of independenec 
which characterizes the civil and political institutions of our 
country." However much patriotic zeal may prompt an 
inclination to accept this view, let no American ignore the 
fact already stated, that the way to progress in obstetrics 
was pointed out by the great Englishman, Hunter; and 
that in the very first year of the new century a similar im- 
pulse was given to gynaecology by the eminent Frenchman, 
Recamier. 

The greatest advances which have been made in the science 
and art of medicine in modern times have all been due to the 
subordination of facts to physical investigation and demon- 
stration. The prodigious strides made in pathological ana- 
tomy during the time intervening between Morgagni and 
Yirchow have been due to the microscope. The great 
modern advance which has been made in the diagnosis, 
prognosis, and treatment of cardiac and pulmonary affec- 
tions, has resulted from the discovery of auscultation and 
percussion. Diseases of the deep structures of the eye 
have been comprehended through the instrumentality of 
the ophthalmoscope. The laryngoscope has brought order 
out of confusion in affections of the larynx; and clinical 
thermometry has done more than anything else in our cen- 
tury to remove diagnosis and prognosis from the domain of 
speculation, and place them upon a scientific basis. At the 
commencement of the present century such an influence was 
evoked in behalf of gynaecology in the speculum uteri, with 
which Recamier, in 1801, began the study of the diseases 
of female sexual organs. 

The history of few instruments which have come down to 
us from ancient times can be so clearly traced as this. 
Directly back through the ages which intervene between 
our civilization and that of the Greeks, its existence can be 
detected ; and yet its merits and advantages had been gradu- 



224 OBSTETRICS AND GYNAECOLOGY. 

ally so lost sight of lliat Rccamier may be said to liave re- 
discovered it at the time just mentioned. The labours of 
this man, more tiian those of any other in modern times, have 
advanced gynecology, and given to it its present position of 
dignity and usefulness. 

The duty of presenting a summary of America's contribu- 
tion to obstetrics and gyni3ecology from the time of Hunter 
and Kecamier to our own, is truly an arduous one. So 
extensive is the literature which has been contributed to 
these snlijects that even a faithful examination of it is diffi- 
cult. Much more difficult is the task of separating the wheat 
from the chaff in the material presenting itself, for, verily, 
there is a surprising amount of both to be found. 

In 1806, Dr. George Clark^ reported a case of extra-ute- 
rine pregnancy, where, the head of the child presenting in 
the rectum, he passed his entire hand into the bowel, and, 
seizing the head, extracted it. Some time afterward the 
body and secundines were spontaneously expelled. In this 
ease the operation proved the practicability of introducing 
the whole hand into the rectum without doing serious dam- 
age to that viscus, and demonstrated the utility of so doing 
in just such cases as that here recorded. In this course 
he has since been imitated by Duncan, of Edinburgh, and 
Janvrin, of New York. Simon's recent advocacy of the 
procedure, for other purposes, is well known. 

The year 1807 was signalized by two important occur- 
rences in American medicine, the introduction of ergot into 
the materia medica as an oxvtoxic, and the ])ublication of 
the first work on midwifery which appeared in this country. 
Long before that time ergot had been known, and in Ger- 
many, France, and Italy had even been empirically used by 
midwives as a uterine stimulant. The name of the drug, 
indeed, in the German tongue is miiiterhom. To John 

^ Phila. Med. Museum, 1606, vol. ii. p. 292. 



OBSTETRICS AND GYNECOLOGY. 225 

Stearns, first president of the N. Y. Academy of Medicine, 
belongs the credit of demonstrating its oxytoxic effects to 
the medical profession, and giving it its deserved position 
as the most reliable and valuable of this class of agents. 
His first communication, dated Jan. 25, 1807, was written 
from his residence in Saratoga County to Mr. S. Akerly, 
and published in the N. T. Medical Repository} This at- 
tracted great attention, gave rise to many others of similar 
character, and very soon obstetrics had at its disposal a 
most valuable agent, capable of accomplishing a result with 
almost certainty which none other, discovered either before 
or since, has been able to effect. Ergot to day stands un- 
rivalled as an oxytoxic among drugs, and the good which 
has resulted from its use in post-partum hemorrhage is in- 
calculable. 

The first work upon obstetrics which appeared from the 
pen of a native author was that of Dr. Samuel Bard, of New 
York. This was published in 1807, and in 1819 had reached 
the fifth edition. In his preface Bard especially disclaims 
all originality, and declares that his work is a compend for 
the use of midwives and practitioners. The style of this 
work, though quaint, is strikingly simple, and the author 
appears to have been a careful, conscientious, and conser- 
vative practitioner. 

" I confess," says he, '' not without severe regret, that towards 
the end of thirty years' practice, I found much less occasion for 
the use of instruments than I did in the beginning ; and I believe 
we may certainly conclude that the person who, in proportion to 
the extent of his practice, meets with most frequent occasion for 
the use of instruments, knows least of the powers of nature, and 
thut he who boasts of his skill and success in their application 
is a very dangerous man." 

It was during this, the first decade of the nineteenth cen- 



'es 



Vol. v., 2d Hexade, p. 308. 



226 OBSTETRICS AND GYNECOLOGY. 

tury, that the greatest of all the contribntions which the 
United States has had the good fortune to make to gynae- 
cology, came forth from the then far west; a region from 
which so great an advance would at that early period have 
been least expected. This was the performance of ovario- 
tomy by Ephraim McDowell, of Danville, Kentucky. The 
magnitude and importance of the procedure, the obscurity 
of its originator, and the fact that its practicability had 
long before been stated b}^ eminent European authorities, 
all combined to render McDowell an object of distrust and 
obloquy. Many, both here and abroad, sympathized with 
the sarcastic ex|)ression of the then editor of the Medico- 
Chirurgical Review:^ " A back settlement of America — • 
Kentucky — has beaten the mother country, nay, Europe 
itself, with all the boasted surgeons thereof, in the fearful 
and formidable operation of gastrotomy, with extraction of 
diseased ovaries." Had this been stated in sober earnest, 
it would have been a modest and simple expression of what 
time, after a most searching examination, has proved to be 
the truth. It was, however, written in the bitterest spirit 
of sarcasm, the cloven foot of which is soon made apparent 
by the occurrence of this sentence : " Our skepticism, and 
we must confess it, is not yet removed." 

Upon reflection, with the facts of the case clearly before 
us, the success of the western surgeon is not a matter of so 
great surprise. He was no illiterate, inexperienced, and 
rash adventurer, but a surgeon who had sat in his student 
days at the feet of John Bell and other eminent men, at 
that time composing the faculty of medicine at Edinburgh. 
"Every seminary of learning," says Sir Joshua Reynolds 
in one of his academical discourses, "is surrounded with 
an atmosphere of floating knowledge, where every mind 

' Dr. James Johnson, Med.-Chir. Rev., N. S. vol. v., Oct. 1826, 
p. 620. 



OBSTETRICS AND GYNECOLOGY. 227 

may imbibe somewhat congenial to its own original concep- 
tions." In Edinburgh the yonng Amei'ican student im- 
bibed some of this floating knowledge, and undoubtedly had 
the seed sown which afterwards ripened so lustily ; for at 
that very time hints and suggestions as to ovariotomy were 
often thrown out by his teachers. Returning home, how- 
ever, he bided his time. Before essaying his great concep- 
tion he had already achieved a high reputation as a surgeon 
for lithotomy and hernia, and for fourteen years he cherished 
and reflected u)ion the idea of operating for extirpation of 
an ovarian tumour before an occasion offered for so doing. 

It is evidently at variance with all the evidence at our 
disposal in reference to this discovery, to conclude that it 
was made by a sudden stroke of genius on the part of its 
discoverer. It should not be forgotten that what is styled 
genius is only the power of suddenly drawing deductions 
from premises slowly, carefully, patiently stowed away in 
the mind, studiously analyzed, and thoughtfully considered. 
Sir Isaac Newton expressed this opinion when, being 
complimented upon his genius, he replied that, " if he had 
made any discoveries it was owing more to patient atten- 
tion than to any other talent." In our day metaphysicians 
are agreed in defining genius as a power of concentrating 
the mind in prolonged, fixed, and continued attention. 
Buffon tersely styles it a "protracted patience." 

In 1809 the long-wished-for opportunity presented itself 
to McDowelV and he operated successfully ; then again in 
1813, and again in 1816 ; although he did not publish these 
cases till 1817. What a commentary upon the grand nature 
of the man was this calm deliberation and hesitancy to rush 
into print I He had performed an operation never before 
attempted in the history of the world, and with three suc- 

1 Eclectic Repository and Analytic. Rev., April, 1817, p. 242. 



228 OBSTETRICS AND GYNECOLOGY. 

cessive good results, and yet he did not hasten to blazon it 
abroad ! 

A great deal has been said, and very properly said, con- 
cerning the fact that McDowell got the suggestion of ovari- 
otomy from abroad, and only developed it afterwards in his 
own country. Even had McDowell never lived, America 
seemed destined to be connected with this great surgical 
triumph from its inauguration ; for in July, 1821, Xathan 
Smith, then Professor of Surgery in Yale College, performed 
ovariotomy^ entirely without the knowledge of the fact that 
he had been preceded by one of his own countrymen inl809, 
and by a German in 1819. 

The scope of this paper will not admit of a record of the 
names of the immediate followers of these surgeons ; suffice 
it to say that before the year 1850 eighteen operators had 
successfully performed thirty-six operations, with twenty-one 
recoveries and fifteen deaths. 

In England ovariotomy was never performed till 1836 ; 
in Germany it was first performed in 1819, and in France 
in 1844. 

It will thus be seen that this operation, remarkable at 
once for its simplicity and efficiency, did not rapidly ad- 
vance to a recognized place as one of the resources of sur- 
gery, but slowly and painfully overcame the prejudices and 
doubts of worthy men, and the misrepresentations of detrac- 
tors. In effecting this result, America by no means stood 
alone. Nevertheless it was to Americans, the successors 
of McDowell, that it was in great part due. The names 
most intimately connected with the work are those of John 
L. and W. L. Atlee, Dunlap, Peaslee, and Kimball. To 
the Atlees too much credit in this regard cannot be accorded. 
Profoundly impressed with the importance and future useful- 
ness of the procedure, they pressed onward in the work of 

' Am. Med. Recorder, 1822, vol. v. p. 124. 



OBSTETRICS AND GYNECOLOGY. 229 

establishing its claims with that dignified indifference to the 
criticisms of opponents which always characterizes success- 
ful innovators. They operated upon all suitable cases, when 
each venture insured a storm of censure; when every fatal 
result was cited in evidence of their recklessness; when 
persistence robbed them of the esteem of many whose good 
feeling they could not but value. 

"On the 17th September, 1843," writes Alexander Dun- 
lap, of Springfield, Ohio, " I performed my first ovariotomy, 
and carefully wrote out the case for publication, and sent 
it to a medical journal. They sent it back, with a note, 
stating that they could not publish the case of such an un- 
justifiable operation. I threw it into the waste-basket, de- 
termined to write no more for medical journals ; but, being 
satisfied that I was right, to continue the operation. From 
that time, for a number of years, I was looked upon by most 
of the profession out west as a kind of an Ishmaelite in the 
regular profession in regard to surgery, and in that opera- 
tion in particular. ... I have now operated 106 times for 
ovariotomy (1876), with 27 deaths and 79 cures." Peaslee 
operated first in 1850 and Kimball in 1855. 

Let it be borne in mind that these operators, with a few 
others, for a long time, stood almost alone. In those days 
it was as difficult to find a physician bold enough to sustain 
the operation as it now is to find one who dares decry it, 
and the wisest and most eminent surgeons of our country 
did not hesitate to declare,^ "that in a few years the mea- 
sure will be consigned to the oblivion it so richly merits." 
This, indeed, was a mild expression of disapprobation com- 
pared with many others from the best men in our ranks. 
Let us rather draw the veil over the exhibition of vitupera- 
tion and personal abuse which disgraced the opposition, 
and strive to forget that the bigotry and narrow-mindedness 

1 Listen and Mutter's Surgery, 1847, p. 422. 
20 



230 OBSTETRICS AND G YN.^ECOLOG Y. 

which endeavoured to crnsh the great discovery of Coper- 
nicus still lived in our dav, to strive ngainst ovariotomy. 
** Pride," says Sir William Hamilton, " has led men to close 
their eyes against the most evident truths which were not 
in harmony with their adopted opinions. It is said that 
there was not a physician in Europe above the age of forty 
who would admit Harvey's discovery of the circulation of 
the blood." 

To-day, when ovariotomy is generally accepted as a valu- 
able surgical resource, it is difficult for one to appreciate 
the reasons for the tardiness with which it overcame Euro- 
pean prejudices, and forced its claims upon the notice and 
confidence of men who have since learned to accord to the 
procedure its true value. So entirely has this disposition 
on the part of trans-Atlantic surgeons been now overcome 
that a very general nnd, we are forced to say, a very reason- 
able feeling of surprise has been excited in America at what 
has seemed to be an inclination to ignore her indisputable 
rights in the matter. 

"Till 1858," says an ovariotomist of Great Britain, as 
well known for his personal excellence as for his skill and 
success as an operator, writing as late as 1873, "I could 
find nothing whatever anywhere to encourage, but every- 
thing to deter one from attempting it. Ovariotomy was 
then, as an operation, simply nowhere."^ This was a mis- 
take. Ovariotomy since 1809 was somewhere; namely, in 
the land in which McDowell had performed thirteen opera- 
tions with eight undoubted successes before 1830; W. L. 
Atlee^ fourteen operations prior to 1851; J. L. Atlce^ 
double ovariotomy in 1843; and where over twenty-five 
other surgeons had removed ovarian tumours each one or 

• Mr. Thos. Keith, Brit. Med. Journ., Dec. 20, p. 739. 

2 Am. Jouru. Med. Sci., N. S., vol. xxix. p. 387. 

3 Ibid., N. S., vol. vii. p. 44. 



OBSTETRICS AND GYNAECOLOGY. 231 

more times prior to the year in which this eminent com- 
mentator began to discover tlie whereabouts of the proce- 
dure. The only extraordinary thing connected with the 
matter is that so important an operation could for almost 
an entire half century have so completely concealed its 
huge proportions from the ken of so acute an observer, and 
that too in a country teeming with medical periodicals and 
a. nation not prone to hide its light under a bushel. 

England, France, and Germany have each in turn been 
claimants of an operation, which after the most critical and 
thorough search stands fully accredited to America. "In 
faith, 'twas strange, 'twas passing strange," and yet 'twas 
true, that a surgeon of the Western wilds, with what Piorry 
once styled "une andace Americaine," stole a march upon 
the polished savans of the old world, as if in the silent 
watches of the night. 

It is difficult to estimate the amount of good which this 
operation has bestowed upon humanity! Practised to-day 
in every civilized country in the world, yielding the statis- 
tics of seventy lo seventy-five per cent, of recoveries, and 
daily being improved in its various steps, it may well be 
regarded as one of the greatest surgical triumphs of the 
century. "It may be shown," says Peaslee, "that in the 
United States and Great Britain alone, ovariotomy has, 
within the last thirty years, directly contributed more than 
thirty thousand years of active life to woman, all of which 
would have been lost had ovariotomy never been performed." 
To have done this even for one generation alone is glory 
enough for one mortal, and his country, apparently in re- 
cognition of this fact, leaves his grave without a mark, and 
his memory to be preserved only in the hearts of the thou- 
sands of grateful women whom his genius has saved from 
death. 

Should the day ever arrive in which the memory of 
McDowell shall be honoured by a monument, surely no one 



232 OBSTETRICS AND GYNECOLOGY. 

will deny to it the right to that inscription which declares 
upon the statue of Washington ; he "has rendered his name 
dear to his fellow-citizens, and given the world an immortal 
example of true glory." 

In the year 1816,* John King, of Edisto Island. South 
Carolina, performed one of the most remarkable operations 
for removal of an extra-uterine foetus ever placed on record. 
The case was one of abdominal pregnancy; the head pre- 
sented in the pelvis, outside of the vagina; he cut through 
the walls of the latter, and applying the forceps, while ab- 
dominal pressure was exerted upon the child from above, 
had the rare good fortune to save both mother and child. 

Towards the close of the eighteenth century there arose 
a man whose genius left its impress upon American obstet- 
rics more decidedly than that of any other has done before 
or since. Decided in opinion, vigorous in expression, terse 
in argument, and trenchant in style, he did a great deal 
towards elevating the department to which he devoted him- 
self. William Potts Devvees was born in 1168 and died in 
1841, after a long and laborious professional career, during 
which he exerted a powerful influence as Professor of Mid- 
wifery in the University of Pennsylvania, and a writer upon 
obstetrics, gynjEcology, and pediatrics. 

In after times it is impossible to estimate the degree of 
influence which has been exerted by such a man as Dewees. 
It is a matter of tradition only, and we can merely point 
to the Uter(E scriptce which outlive him. He contributed a 
Treatise on the Diseases of Females (1820), which w^ent to 
the tenth edition ; a Treatise on the Physical and Medical 
Treatment of Children (1825), which reached the tenth edi- 

J Med. Repository, 1817, N. S., vol. iii. p. 388. See also "An 
analysis of the subject of extra-uterine foetation, and of the retro- 
version of the gravid nterus, by John King, Esq., of South Caro- 
lina." Norwich, 1818, 8vo. pp. 176. 



OBSTETRICS AND GYNECOLOGY. 233 

tion : and a Comprehensive System of Midwifery (1824), 
which went into a twelftli edition. Of tlie last Prof. Hngh 
L. Hodge^ declared "it takes a stand decidedly in advance 
of Denman, Osborne, Burns, and other English authorities 
in general use in our country at that period, and even of 
Baudelocque himself in throwing aside from his excellent 
system much that was useless, and, it may be said, imagi- 
native." 

Devvees had two able successors in Meigs and Hodge, 
both of whom reached old age in the active performance of 
their professional duties, and left indelible traces of their 
influence by reason of their strong intellectual qualifications, 
valuable literary contributions, and rare personal worth. 

Charles D. Meigs was born in Bermuda in 1792, and 
commenced practice in 1815. For many years he filled the 
chair of obstetrics in the Jefferson Medical College of Phi- 
ladelphia, and contributed largely to medical literature. 
His most important works were Woman, her Diseases and 
Remedies (1847); Obstetrics, the Science and Art (1849); 
a Treatise on Acute and Chronic Diseases of the Neck of 
the Uterus (1850); and on the Nature, Signs, and Treat- 
ment of Childbed Fevers (1854). 

Meigs^ drew special attention to cardiac thrombosis as a 
cause of those sudden deaths which occur in childbed, and 
which had generally been attributed to syncope. "I had 
noticed, on various occasions, the total want of any means 
of explaining such disasters," says he, referring to sudden 
deaths post partum, "and remained as much in the dark as 
my compeers, until I discovered that the incident depends 
most commonly on the sudden coagulation of the blood that 
occupies, for the time, the right auricle of the heart, and, in 

1 Memoir in Amer. Journ. of Med. Sci., Jan. 1843. 

2 Med. Examiner, March, 184!^, p. 141. 



234 OBSTETRICS AND GYNECOLOGY. 

some of the cases, even that which is in the ventricle, and 
the pulmonary artery."^ 

It has been remarked by an eminent American author 
that Meigs "just escaped the honour, which is now, and will 
hereafter be given to the eminent Virchow, of Berlin, of a 
great pathological discovery." Even admitting the truth of 
this statement, it is certainly well that the justice of the 
award should here be questioned. Meigs proclaimed the 
fact in no uncertain or wavering tones, but boldly, decidedly, 
repeatedly, and by every method. Why is the honour not 
his? What else could he have done to deserve it? Many 
of his countrymen will sympathize with the voice which 
speaks now, after death, in this unmistakable manner. "1 
have a just right to claim the merit of being the first writer 
to call the attention of the medical profession to these sud- 
den concretions of these concrescible elements of the blood 
in the heart and great vessels." It may be said that he 
did not follow his discovery into detail as regarded secondary 
deposits of emboli. What of that? He does not claim to 
have done so. What he does claim is clearly and unquestion- 
ably claimed with justice. 

The style of Meigs was peculiarly quaint and antique. 
Yet he possessed in a remarkable degree the power of fixing 
salient points upon the mind of the reader or listener, and 
burning into the memory the maxims which he deemed of 
greatest importance. Meigs died June 22, 1869. 

Hugh L. Hodge practised in Philadelphia from 1818 to 
1873, during which period he exerted a wide and decided 
influence as Professor of Obstetrics and Diseases of Women 
in the University of Pennsylvania, and as the author of a 
number of valuable works upon these and kindred subjects. 
His most valuable contributions to literature were Cases 
and Observations regarding Puerperal Fever (1833) ; Dis- 

' Treatise on Obstetrics, 5tli ed., p. 352. 



OBSTETRICS AND GYNECOLOGY 235 

enses Peculiar to Women, inclndinf>: Displacement of the 
XJterns (1860) ; Principles and Practice of Obstetrics 
(1864) ; and Essays upon Synclitisra of the Foetal Head 
(1870-71).' In his essays and lectures Hodge made pro- 
minent, by precept and illustration, the value of forceps as 
compressors in ordinary delivery, and after perforation ; 
synclitism of the foetal head ; the importance of the in- 
duction of premature labour where even without pelvic de- 
formity repeated foetal deaths have occurred from premature 
ossification; the prophylactic influence of mechanical sup- 
port in prevention of habitual abortion, and its efiBcacy in 
cases of uterine fibroid ; and added to the armamentarium 
obstetricum " Hodge's Forceps," the instrument more gene- 
rally used in this country than any other; a compressor 
cranii ; a craniotomy scissors; and placental forceps — all 
attesting rare mechanical ingenuity. 

For gynaecology Hodge accomplished much by the origi- 
nation and development of two ideas which have already 
done a great deal of good, and will in the future do more 
than they have yet accomplished. The first of these in- 
volved the recognition of the fact that that state of the 
uterus characterized by enlargement, tenderness, displace- 
ment, congestion, and hypersecretion is not "inflammation," 
and should not be treated as such ; the second, that a double 
vaginal lever can supplement the exhausted uterine supports 
under these circumstances, and by sustaining the uterus give 
great relief to all these conditions. With regard to the first 
of these views, nothing more can be stated here than the ex- 
pression of the belief that it constitutes one of the most 
important facts in uterine pathology. As to the second, 
something is necessary. Prior to the time when Hodge 
began a course of careful, laborious, and conscientious ex- 
periments upon the shape, material, uses, and varieties of 

• Am. Journ. Med. Sci., Oct. 1870, p. 325, and July, 1871, p. 17. 



236 OBSTETRICS AND GYNAECOLOGY. 

pessaries (1830), tliese instruments had been used both in 
this country and in Europe. Indeed, even as long ago as 
the period of the Greek civilization they had been employed. 
But the disk, the globe, and similar instruments were badly 
contrived, did not depend upon any true mechanical prin- 
ciple, and accomplished little by comparison with what 
Hodge's improved instruments have since done. He in- 
troduced the philosophical double lever, gave accurate and 
precise rules for replacing and sustaining the displaced 
uterus by it, insisted upon every pessary sustaining itself 
against the vagina instead of against the rami of the pubes, 
particularly urged that after being placed both uterus and 
pessary should be movable in tlie pelvis, and thus brought 
a subject which had before belonged to the realms of empi- 
ricism into the precincts of science. Hodge's pessary is 
unquestionably the parent stem from which the host of 
excellent modifications now existing took their rise. It may 
safely be averred that he accomi)lished more for mechanical 
support of the uterus than any one has ever done before or 
since his time. He first constructed these instruments out 
of silver which was plated lightly with gold, but in time he 
used vulcanite or hard rubber entirely. 

Hodge once gave to a friend this account of the consum- 
mation of the discovery of the lever pessary: " He had been 
contemplating for a long time the subject of new shapes for 
pessaries, and after many experiments had found nothing 
satisfactory. One evening, while sitting alone in the room 
where the meetings of the Medical Faculty of the University 
were held, his eyes rested on the upright steel support by 
the fireplace, designed to hold the shovel and tongs. The 
shovel and tongs were kept in position by a steel hook, and 
as he surveyed the supporting curve of this hook, the 
longed-for illumination came ; the shape, apparently so 
paradoxical, revealed itself in the glowing light and flicker- 
ing flame of the burning grate, and the Hodge lever pessary 



OBSTETRICS AND GYNECOLOGY. 237 

was the result."^ A sudden effort of genius, was it ? No : 
this was the moment at which tlie detached thoughts, long 
and carefully stored away in the inventor's mind, combined 
to form a harmonious whole. The steel hook did for his 
mind what the swinging church lamps did for that of Galileo 
in suggesting the pendulum. 

Henry Miller was born in Kentucky, in 1800, commenced 
practice in 1821, and published a work upon Human Par- 
turition in 1849, and upon the Principles and Practice of 
Obstetrics in 1858. He was for a long period Professor of 
Obstetrics and Diseases of Women in the University of 
Louisville, and both as teacher and writer decidedly influ- 
enced the department to which he devoted his energies. 
We owe to him the method of making the application of 
fluid caustics to the cavity of the body of the uterus by 
saturating with them a cotton wrapped rod or probe, and 
he was among the first to adopt the use of the speculum 
uteri in the great West, and the first to employ in that part 
of our country anaesthesia in midwifery. 

In 1819 the chair of obstetrics in the College of Physi- 
cians and Surgeons of New York was filled by one who 
will long be remembered for his eloquence, erudition, and 
rare geniality — John W. Francis. Unfortunately for the 
department which now engages our attention, Dr. Francis 
turned his literary efforts in the direction of general medi- 
cine, literature, and pathology. Little remains to us of his 
obstetrical writings except his copious annotations of Den- 
man's Midwifery, which he edited in 1821. A perusal of 
these makes one regret that he did not leave behind him 
more extensive contributions to this department embodying 
more of his large experience and acute observation. 

The next systematic writer upon this department in the 

' Discourse Commemorative of H. L. Hodge, M.D., by R. A. F. 
Penrose, M.D., Phila., 1873. 



238 OBSTETRICS AND GYNECOLOGY. 

United States was Gunning S. Bedford, who practised in 
New York from 1830 to 1868; was for over twenty years 
Professor of Obstetrics in tlie University Medical College, 
and published a work on Diseases of Women and Children 
in 1855, and another on the Principles and Practice of 
Obstetrics in 1861. 

In the year 1841, Bedford established, in connection with 
the University Medical College of New York, the first clinic 
for the diseases peculiar to women ever held in this country. 
This he maintained with great ability, energy, and enthusi- 
asm, and from it he gleaned the material for a work which 
created a very decided sensation both in this country and 
in Europe. This clinic, under the care of his able succes- 
sors, Charles A. Budd and M. A. Pallen, still exists. But 
it has been the parent of many other similar ones not only 
in New York but throughout our country. No medical 
school, indeed, is now considered complete without such a 
sphere for the instruction of students, and a vast deal of 
good has resulted from his move in this direction. 

Thus far this essay has chiefly dealt with the labours of 
those of a past generation who, in the early part of the 
century, sustained the department of which we write ; and 
the careers as well as the works of individuals have been 
noted. From this point we are called uj)on to undertake 
the more delicate and far more diSicult task of dealing with 
the labours of our contemporaries. The chief reason for 
the difficulty and delicacy of this duty grows out of the fact 
that nothing is harder than to arrive at a just appreciation 
of the merits of contemporaries, more especially on the part 
of those labouring in the same field. Prejudice, personal 
bias, and that tendency which all men feel to undervalue 
what is at their own doors, and exalt that to which distance 
lends enchantment, all combine to defeat a just, fair, and 
generous estimate. Then, too, the umpire, however con- 
scientious and unprejudiced he may be, lacks the great 



OBSTETRICS AND GYNECOLOGY. 239 

assistance which tlie test of experience alone can give in 
deciding as to the value of new procedures and the credit 
which should be accorded to their discoverers. He has not 
the opportunity of learning the verdict of time as to what is 
and who are the fittest to survive ; of that " wise beneficent 
law by which the improvement and perfection of the human 
race alone can be secured ; that law in consequence of which 
the best specimens of a species survive, and become the pro- 
genitors of generations more perfect than those preceding 
them." The only feelings which can sustain him who makes 
the efi'ort and render him impervious to the shafts of criticism, 
is an abiding faith in the rectitude of his intentions, and in 
the sincerity of his efforts to render to every man, without 
prejudice. or favour, what he honestly regards as his just 
dues. 

The plan which suggests itself as best is to notice, 1st, 
the original discoveries which have proved of greatest 
practical value ; 2d, the most striking and important con- 
tributions to periodical literature and systematic works 
upon the subject ; od, instruments and mechanical contri- 
vances of greatest importance. 

In the year 1841 a most important contribution was made 
to the treatment of peritonitis by Alonzo Clark, ^ of New 
York, in the introduction of the plan now known as the 
"opium treatment." In the spring of that year Dr. Clark 
saw several cases of this disease treated by Armstrong's 
raethod — a full bleeding, and a full dose of opium, to pro- 
long the effects of the bleeding. He was impressed with 
the idea that opium was the curative agent, not the bleed- 
ing. In the next three years he treated all the cases he 
met on that idea, giving opium, or an opiate, in full and 
frequent doses, and nothing else. The result was that just 

^ New York Journ. of Med., Jan. 1858, p. 82 ; and Ramsbotham's 
Syst. of Obstetrics, Am. ed., Phila., 1855, p. 533. 



240 OBSTETRICS AND GYNECOLOGY. 

eight out of nine cases were cured. A success very en- 
couraging, but not quite so marked, attended the similar, 
subsequent use of the drug. With this experience he re- 
solved to give it a trial in puerperal peritonitis. The 
opportunity, however, did not occur till 1848. The first 
trial was successful, the patient taking 100 grs. of opium in 
four days. Between that date and 1852 nothing occurred 
that was decisive regarding the merits of the plan. But in 
the latter year an epidemic of puerperal fever occurred at 
Bellevue Hospital, in which the exclusive opium treatment 
was fully tested by him. In the first case it failed, or 
rather through the timidity of the House Physician, it was 
not tried — only three grains of opium were given in twenty- 
four hours. A few days later four cases came under his care 
at once. He assigned them to another member of the 
House Staff, a man of more decided character, now a dis- 
tinguished surgeon and sanitarian, with detailed instructions. 
All of these were cured. It was in the course of this out- 
break that the opium treatment for puerperal peritonitis was 
shown to be the best that had then, or has since, been pro- 
posed. This physician assisted in the treatment of puerpe- 
ral fever in the same hospital twelve years earlier, in which, 
out of thirty attacked, twenty- nine died. Nothing was then 
known of the antiphlogistic power of opium. 

The quantity of opium, or one of its alkaloids, required 
to subdue and control the inflammatory process varies 
greatly. In some cases two grains of powdered opium every 
two hours answers the purpose, while in others eighty drops 
of Magendie's solution (xvj grs. of morphia to one ounce of 
water) every two hours for six or seven doses are required. 
Dr. Clark records a case in which the patient took during 
" the first twenty-six hours, of opium and sulphate of mor- 
phia, a quantity equivalent to 106 grains of opium ; in the 
second twenty-four hours she took 472 grains, on the third 
day, 236 grains, on the fourth day, 120 grains, on the fifth 



OBSTETRICS AND GYNAECOLOGY. 241 

day, 54 grains, on the sixth day, 22 grains, and on tlie 
seventh, 8 grains." 

By this system a tolerance of the drug is rapidly effected, 
pain is annihilated, nervous'and mental disquietnde relieved, 
and the most satisfactory results commonly attained. While 
it is put in practice, however, a physician should constantly 
remain by the bedside to detect the development of danger- 
ous narcotism, and combat it by appropriate means. It is 
surely not claiming too much for Clark's method to assert 
that it surpasses in efficacy all others which have yet been 
made known to the profession. 

In 1844, Dr. J. C. Nott,^ of Mobile, published a case of 
"coccygeal neuralgia," in which he practised extirpation of 
the bone, which proved to be carious, with entire relief to 
his patient. This was the Srst time that either this disease 
or its remedy had been described. At a later period Sir 
James Simpson, not knowing of Nott's essay, described the 
disease under the name of coccyodynia or coccygodynia, 
and advocated the same method of treatment. 

Although a decided impulse was given to gynaecology by 
the introduction of the speculum by Recamier, a great need 
was felt of something which would expose the uterus and 
vagina to more complete and satisfactory investigation. For 
want of this the cure of vaginal fistulce had thus far proved 
impracticable, and many operations upon the uterus itself 
difficult of accomplishment. In 1852 there appeared an 
article from the pen of a hitherto unknown author, which 
changed all this, and threw a flood of light into dark places. 
This was an essay upon vesico-vaginal fistula, by J. Marion 
Sims,2 then of Montgomery, Alabama, in which he intro- 
duced a speculum which developed a new principle of ex- 

' New Orleans Medical Journal, May, 1844, p. 58; and Am. 
Jouru. Med. Sci , Oct. 1844, p. 544. 

2 American Journ. Med. Sciences, Jan. 1852, p. 59. 
21 



242 OBSTETRICS AND GYNECOLOGY. 

amination of the uterus and vagina. The discovery of a 
method of cure for vaginal fistulas was a great stride onward, 
but the method of examination by retraction of the perineum 
and posterior vaginal wall, while the body of the patient is 
so placed as to secure distention of the vagina by air, has 
served to give to gynecology an impulse second in import- 
ance only to that given by Recamier. Recamier's discovery 
lifted this department from the field of speculation to that 
of science. Sims has served to advance it very greatly be- 
yond the point which it would have occupied if reliance were 
still placed upon previous methods. 

Important discoveries are not made suddenly as if by one 
leap on the part of some great intellect. They are arrived 
at slowly, step by step, and by the workings of many minds ; 
as many unseen influences slowly mature a harvest which in 
due time falls to one sickle. The inspiration of discoverers 
is the offspring of the times in which they live ; such men 
are exponents of the mental workings of their period, mouth- 
pieces of the civilization which developed them. The re- 
sultant of the premises evolved from ten great minds of one 
decade are often combined in the deductions of a single 
genius in another. Hence it is that discoveries are often 
simultaneously made in various parts of the world by men 
who have had no communication with each other, and that 
their origination is invariably disputed by rival claimants. 
Morse discovered the telegraph, but ever since Franklin's 
kite brought down the lightning from the skies, many others 
had been preparing the way for him. Wells discovered 
anassthesia, but for many years before, school-boys had for 
their amusement been- painlessly bruising themselves under 
the influence of laughing-gas, never dreaming that the 
means of securing unconsciousness of pain which they 
adopted would one day become systematized and utilized as 
a great boon to humanity. 

These remarks find no more perfect illustration in the ■ 



OBSTETRICS AND GYNECOLOGY. 243 

discoveries of snr<rery than that of the cure of vesico-vafrinal 
fistula. The writings of the Greek, Roman, and Arabian 
schools of medicine are sino^ularly silent with reference to an 
accident which has a striking faculty of pressing itself upon 
the attention, and must have been very common before the 
days of the Chamberlaynes. From the times of Pare, how- 
ever, it attracted the special care of surgeons, and year after 
year efforts were made to close these small, but important, 
lesions. It would take too much space to tell of the efforts 
of Pare, Roonhuysen, YoeUer, Fatio, and many others; 
suffice it that at the beginning of the nineteenth century 
nothing had been accomplished. In the eighteenth, how- 
ever, " coming events cast their shadow before," and the 
glimmer of the dawn became visible in the operations, and 
occasional successes of Desault, Naegle, Schreger, Lalle- 
mand, and Roux. In 1834 Gossett, of London, absolutely 
discovered the method of cure, and, his labours being for- 
gotten, Metzler, of Prague, in 1846, again did so. And 
now, too, Hayward and Mettauer, of this country, began 
to get good results. But sporadic, desultory, haphazard 
results mark a different era from systematic and certain ones, 
and the matter may be said to have been really little ad- 
vanced till Marion Sims published to the world his method 
of treating these accidents, which was at once so simple and 
systematic as to place the procedure at the disposal of every 
surgeon. 

No more forcible comment can be made upon the perfec- 
tion of Sims' procedure than the mere citation of the fact 
that even now it stands, for the great majority of surgeons, 
virtually unaltered, and as simple in details as when it left 
the master- hand. 

Various modifications have been suggested both in this 
country and in Europe. Chief among these are the clamps 
of Battey, Atlee, and Bozeman. The last of these only de- 
serves special mention on account of the excellent results 



244 OBSTETRICS AND G Y N.^^CO LOG Y . 

which have been obtained with it by its originator, Xatiian 
Bozeraan. This operator,, who was the earliest to follow 
Sims in this field of snrgery. and who has devoted himself 
to it with an earnestness which has been surpassed by that 
of no other, has always preferred a modification of the 
knee-elbow position to that on the side, and has approxi- 
mated the pared edges of the fistulous orifice by passing his 
sutures through a leaden shield, or, as he styles it, a " button 
suture." By tliis method very gratifying results are obtained, 
and after an experience of more than twenty years with it, 
its originator still em|)loys it with confidence in its advan- 
tages over the suture alone. 

The medical profession in New York, recognizing the 
value of Sims' discoveries, warmly endorsed an effort on his 
part to establish a Woman's Hospital in that city, where, 
tlianks to the well-known generosity of its citizens, such an 
institution was founded in 1855. From this institution, 
through the labours of Sims and his able coadjutor Thomas 
Addis Emmet, a great deal has emanated for the advance- 
ment of gynecology. To these two men a great deal of 
credit is due for establishing and disseminating an exact 
and systematic method in the stud}' of the diseases of women. 
The greater facility afforded for operations upon the vagina 
and uterus by Sims' method of examination, has accom- 
plished an improvement in all such procedures, and these 
two operators, who were first in the field with this advan- 
tage on their side, have been greatly instrumental in this 
result. Operations upon the perineum, upon fistuUe, upon 
constricted and tortuous uterine necks, upon voluminous and 
atonic vaginse, have all felt this influence. Posterior instead 
of lateral section of the cervix for anteflexions of body and 
neck, is a good example of such an improvement as has been 
thus effected. 

Until the establishment of Marion Sims as a specialist 
in diseases of women in Xew York about the year 1852, no 



OBSTETRICS AND GYNECOLOGY. 245 

one in this country liad heretofore devoted himself to this 
dei)artment to the exclusion of general practice. By him 
and by T. A. Emmet and H. R. Storer more than any others, 
this practice was established. That a great deal of good 
has resulted from the devotion of able minds to the special 
investigation of this subject, no candid observer can doubt. 
And yet every thoughtful man who wishes well to the de- 
partment, must view with concern the unwise haste with 
which young practitioners, who have had neither time nor 
opportunity to acquire experience in general medicine, strive 
to devote themselves to it. Can it ever be that he who 
knows little of the management of the diseases which affect 
the peritoneum, stomach, lungs, and liver, can deal efficiently 
with the disorders of an organ or set of organs which are 
especially affiliated with them in all their variations of dis- 
ease, in all their physiological functions? He who deals 
efficiently with the whole, may in detail deal with all its 
parts, but he who learns to deal with a part alone, can never 
be equal to coping with the whole. 

Before the introduction of Sims' method of uterine exami- 
nation, the use of the vaginal tampon, the most important 
of all hemostatic means in connection with the non-pregnant 
uterus and with this organ up to the fifth month of preg- 
nancy, was difficult, painful, and unreliable. The introduc- 
tion of a silk handkerchief, a kite-tail tampon, a mass of 
cotton, a muslin bandage, and all similar materials, was very 
unsatisfactory. The most perfect facility and efficiency at- 
tend tamponing the vagina with wet cotton while the patient 
lies upon the side, and the vagina is dilated by means of the 
duck-bill speculum. Pieces of cotton soaked in water, 
pressed and flattened out by the fingers, each about the 
size of a very small biscuit, are pressed into the vaginal 
cul-de-sac by means of forceps till this is filled. Then other 
pieces are packed firmly around the cervix until only the os 
is visible — a smaller pad is then pressed firmly against or 

21* 



'24G OBSTETRICS AND GYNAECOLOGY. 

introduced within the cervical canal, and the whole vagina is 
then filled to its lowest portion. 

At a meeting of the American ^[edical Association in 
1853, a prize was awarded to a very remarkable and valuable 
essay by Dr. W. L. Atlee,^ entitled, "The Surgical Treat- 
uaiiit of Certain Fibrous Tumours of the Uterus heretofore 
considered beyond the resources of Art." In this Dr. Atlee 
advocated the removal, by enucleation, of tumours which up 
to this time were looked upon as incurable, and by his bril- 
liant results he led the way to a plan of treatment which has 
been productive of a great deal of good. His plan of treat- 
ing these growths is now very^comraonly adopted by practi- 
tioners who appear to forget to whom the heroic and life- 
saving method is due. Even as early as 1850, Prof. Mussey 
of Ohio remarked, " Of all the achievements of modern 
surgery, we meet with none moie striking or extraordinary 
than the operations performed by Professor Atlee for the 
removal of intra-uterine fibrous tumours." 

In 1854, a gold medal was awarded by the Ohio State 
Medical Society to Dr. M. B. Wright of Cincinnati, for an 
essay entitled " Difficult Labours and their Treatment." In 
this essay the operation of bimanual version was so fully, so 
clearly, so unmistakably described, that it is difficult to un- 
derstand how many of his countrymen could have since per- 
mitted themselves to style the procedure by any other name 
than "Wright's Method." An examination of the written 
testimony bearing upon the subject, certainly seems to give 
endorsement to the following claim on the part of Wright. 

" I claim the credit, if credit there be, of having first 
suggested to the profession, and demonstrated in practice, 
the value of bimanual version. "-' 

It must be understood that Wright neither claims nor 

' Trans. Am. Med. As.sociation, 1853, vol. vi. p. 547. 
2 Letter to the author of thi.s review in Jan. 1876. 



OBSTETRICS AND GYNAECOLOGY. 247 

deserves the credit of the discovery of bimanual version as 
a procedure, but only that of the method of its performance. 
Flamand long before him described cephalic version by this 
method, but Wright improved upon and simplified the pro- 
cedure. This is Wright's description of his plan : — ^ 

" Suppose the patient to have been placed upon her back, 
across the bed, and with her hips near its edge — the presentation 
to be the right shoulder, with the head in the left iliac fossa — 
the right hand to have been introduced into the vagina, and the 
arm. if prolapsed, having been placed, as near as may be, in its 
original position across the breast. We now apply our fingers 
upon the top of a shoulder, and our thumb in the opposite axilla, 
or on such part as will give us command of the chest, and enable 
us to apply a degree of lateral force. Our left hand is also ap- 
plied to the abdomen of the patient, over the breech of the foetus. 
Lateral pressure is made upon the shoulders in such a way as to 
give to the body of the foetus a curvilinear movement. At the 
same time, the left hand, applied as above, makes pressure so as 
to dislodge the breech, as it were, and move it towards the centre 
of the uterine cavity." 

All controversial topics should be avoided in an essay like 
the present, but it would be discourteous to a distinguished 
English obstetrician not to note the fact that he has doubted 
the claim of Wright to originality in this matter. In a letter 
published in the Amer. Journ. of Ohsleti^ics, etc., for Feb. 
1873, Dr. Braxton Hicks, of London, says : — 

" Now the distinctive point of the plan I have introduced was 
just this, that both hands are used together, one supplementing 
the other, so that when the internal hand began to lose power 
the external one would begin to gain power, and vice versa. This 
principle was applied by me to both partial and complete ver- 
sion, and it is (as far as I have been able to discover) a curious 
fact that in the practice of neither German nor other obstetri- 
cians has the use of the two hands simultaneously been de- 

' Trans. OLio State Med. Soc, 1854, p. 82. 



248 OBSTETRICS AND GYNECOLOGY, 

scribed. The only use of the outside hand has been hitherto to 
steady the uterus to prevent recession. 'J'his character it is 
which Dr. Richardson' has overlooked, and it is for this that I 
am desirous of claiming for myself whatever of originality it 

possesses." 

This claim is perfectly clear, and can be answered without 
difficulty or circumlocution. Wright says "at ihe same time 
the left^ hand, applied as above, makes pressure so as to 
dislodge the breech, as it were, and move it towards the 
centre of the uterine cavity." Surely no one can suppose 
that this means that the left hand merely steadies the uterus. 
Cazeaux declares that Flamand got hold of the head with 
tlie hand in the vagina, "if tlie efforts made by the other 
hand through the abdominal walls, have not proved sufficient 
to make it descend into the excavation." 

Tliere is no question as to the fact that Dr. Hicks has done 
a great deal of good in simplifying podalic version by this 
method. But the extension and utilization of a method is 
not here at issue ; it is the origination of the principle which 
is in question. 

Even had Wright not made this advance, it seemed des- 
tined to be made in America, for in the next year Penrose,^ 
of Philadelphia, in an article entitled " Ceplialic version in 
shoulder presentations, with the arm in the vagina," de- 
scribed bimanual version without a knowledge of the fact 
that he had been anticipated by Wright. 

During the course of the same year a very valuable con- 
tribution was made to the treatment of septicaemia following 
ovariotomy, by E. R. Peaslee,* of New York. His method 
was the introduction of a catheter or similar tube into the 

' Who maintains Wright's claim. 

2 The right hand is in the vagina. 

3 Medical Examiner, -July, 1855, p. 405. 

4 Am. Jouru. Med. Sci., April, 1863, p. 355, and July, 1864, p. 47. 
See also Amer. Jouru. Obstet., 1870, vol. iii. p. 300. 



OBSTETRICS AND GYNECOLOGY. 249 

peritoneal cavity and boldly washing ont this serous sac, 
interference with which had for all time been regarded with 
so much dread. Experience with the plan, extended now 
over a period of twenty years, stamps it as a reliable me- 
thod of meeting one of the most dangerous consequences 
of this grave operation, and corroborates the high estimate 
which was put upon it in the early days of its existence. 
Unquestionably many lives have been saved by a timely re- 
sort to it. In one of Peaslee's early cases the use of intra- 
peritoneal injections was kept up for fifty-nine days, and in 
another for seventy-eight days. In both of these cases re- 
covery took place as a reward for the prolonged and per- 
severing efforts of the fearless innovator. 

In 1856, Sims made known his operation for narrowing 
the vagina for the cure of prolapsus uteri. In this he had 
been anticipated by Dieffenbach, Ileming, and other Euro- 
peans, but his method was an improvement over others, and 
w^as a revival of what had fallen into almost entire disuse. 

In the same year,' Dr. James T. White, of Buffalo, reduced 
by taxis an inversion of the uterus of eight days' standing. 
In his report of this case he took occasion to predict that 
the profession would soon alter its views with regard to the 
practicability of reposition in chronic cases, a prophecy 
which was happily fulfilled, in great degree in consequence 
of his own labours, two years afterwards. 

Daillez,- who published a thesis upon this subject as early 
as 1803, reported a case of reduction by taxis as late as the 
eighth month after occurrence of the accident ; another is 
reported in 184T ; and even as late as 1852, Canney and 
Barrier are declared to have accomplished it. But the. plan 
was not systematized and placed upon the basis of a recog- 
nized and legitimate procedure until 1858, when White of 

' Buffalo Med. Journ., vol, xi. p. 596. 

2 Coloiubat, Dis. of Women, Am. ed., p. 186. 



250 OBSTETRICS AND GYNECOLOGY. 

Buffalo, and Tyler Smith of London, simultaneously re- 
placed uteri in the condition of chronic inversion, and gave 
to the procedure the position of a standard operation. 

Up to the present date White has successfully reduced by 
taxis twelve cases, extending from seven months to twenty- 
two years in duration. 

In 1858, Gaillard Thomas' published an essay upon the 
treatment of prolapse of the funis by gravitation developed 
as a remedial measure by placing the patient in the genu- 
pectoral position. This plan, which it appears had been 
formerly in use, had been so entirely lost sight of, that for 
ten years after its introduction by him, the fact of its pre- 
vious existence was not known. Since the time of his article 
it has come into general use as the most rational and simple 
method of treating this accident during the earlier stages of 
labour. 

The intractable nature of, and extreme distress attendant 
upon chronic cystitis, are too well known to require mention. 
For a long time the attention of American surgeons has l)eeu 
directed to the relief of this condition ))y surgical means. 
In 1846,"^ Willard Parker created a recto-vaginal fistula in 
the male for the removal of a stone, and being struck by the 
relief afforded to a cystitis which existed, he subsequently 
repeated the operation for the relief of the latter condition 
in men between that time and 1867, when he read an essay 
upon the subject before the Xew York State Medical Society. 
"The object in view," says he, "was to open a channel by 
which the urine could drain off as fast as secreted, and thus 
afford rest to the bladder, the first essential indication in the 
treatment of inflammation." In 1867, Paul F. Eve followed 
Parker's example in thus operating upon the male. But in 

J Trans, of N. Y. Acad, of Medicine, vol. ii. p. 21. 
2 Transact, of N. Y. State Med. Soc, 1S67, p. 345. 



OBSTETRICS AND GYNECOLOGY. 251 

1861/ Natliati Bozeman applied the procedure to the female 
bladder with the result of curing chronic cystitis 

Without a knowledge of any of these facts the same idea 
suggested itself to the minds of Sims and Emmet^ as early 
as 1858, and at a later period, 1861, the latter of these 
gentlemen, at the suggestion of the former made three years 
before, practised the operation for chronic cystitis in the 
female. Although the origination of the method does not 
belong to Emmet, to him is justly due the credit of having 
systematized the procedure, and placed it upon the basis of 
a recognized surgical resource. Whether it is destined to 
give way before the less serious procedure of distending the 
urethra, and thus establishing incontinence of urine, time 
will prove. That it is in itself a most valuable operation, 
no one can doubt who has seen the relief afforded by it to 
women nearly exhausted by ceaseless vesical tenesmus, loss 
of sleep, and nervousness. 

In Smellie's^ Collection of Preternatural Cases and Ohser- 
rations in 31idicifery, vol, iii. p. 232, will be found evidence 
of the fact that that great obstetrician recognized the value 
of gravitation, developed by placing the patient in the genu- 
pectoral position, as an aid to the operation of podalic ver- 
sion. He mentions his having repeatedly resorted to this 
posture in performing version, but does not claim originality 
for it, as he styles it " Daventer's method." The first ease 
in which Smellie resorted to it occurred in 1753. In Wright's 
pamphlet, already alluded to, published in 1854, and entitled 
" Difficult Labors and their Treatment," the following pas- 
sage occurs on page 23 : " The hand can be more readily in- 
troduced into the uterus, and the feet reached, however, with 
the patient on her elbows and knees, than when on the back 

J Transact, of N. Y. State Med. Soc, .1871, p. 326. 

2 Amer. Practitioner, Feb. 1872, p. 65. 

3 Ibid., Jan. 1876, p. 59. 



252 OBSTETRICS AND GYNECOLOGY. 

or sides. There may be cases, in wliieh advantage would be 
gained, by placing the patient in this position, preparatory 
to cephalic version." 

It will be observed that Smellie resorted to the knee- 
elbow position as an adjuvant to podalic version, and that 
Wright very cautiously offers it as a mere suggestion. To 
P. R. Maxon, of Syracuse, N. Y., belongs the credit of 
having established the claims of this method in the perform- 
ance of cephalic version in cases of transverse presentation. 
He thus describes the procedure in the case of a lady who 
had previously lost three children by podalic version. 

" Remembering the fate of the other children, and finding this 
one very large,- 1 suggested the feasibility of correcting this 
shoulder presentation in the same manner as I had corrected the 
abdominal in the first instance. With his (the attending physi- 
cian's) consent, I made the effort in the following manner: I 
folded several quilts compactly, laying them upon one another 
to the height of about one foot, and assisted her to kneel upon 
the quilts with her head and shoulders resting upon the bed and 
her face forwards, so as to bring her body to an angle with the 
bed of nearly 90°. I then pressed my hand gently against the 
shoulders, which readily receded, until I was enabled to clasp 
the vertex with my fingers, and with the assistance of the next 
pain to so ' engage' it that, when the patient was placed upon 
her left side and the quilts removed, a perfectly natural presenta- 
tion presented itself. In a few hours the labour terminated in 
the delivery of a healthy boy, weighing ten pounds." 

No one who has not resorted to Maxon's method can 
appreciate the great facility with which a shoulder or even 
an arm presentation may be altered into one of the vertex ; 
and no one who has done so will doubt the great value of 
the plan. Of course, after the amniotic fluid has been long 
evacuated, and the uterus has firmly clasped the foetal body, 
such a change will often prove impossible ; but in many 
cases, before this unfortunate chain of circumstances has 
occurred, the operation of podalic version with all its serious 



OBSTETRICS AND GYN^OOLOGY. 253 

consequences to mother and child may be avoided, and a 
natural parturition be substituted for an unnatural one. 

In 186 P Sims described the disease known as vaginismus, 
which had, however, been previously noted by Burns, Simp- 
son, Debout, and several others, and recommended for its 
relief a procedure which, while it involves little risk to the 
patient, insures a certain removal of the disorder. This con- 
sists in ablation of the remains of the hymen and section of 
the tissues at the perineal extremity of the ostium vaginae. 

Several European authorities have advocated in prefer- 
ence to this plan forcible distention of the ostium vaginaj 
and modification of the local nervous hyperaesthesia by alte- 
rative applications. A comparison of the two methods at 
the bedside will be greatly in favour of the former. 

In 1862^ E. Noeggerath, of New York, proposed and 
practised the method of reduction of an inverted uterus by 
digital compression of both horns. He based this procedure 
upon the pathological fact that inversio uteri generally be- 
gins by inversion of the horns. Experiment proves the 
method of Noeggerath to be a valuable and reliable one, 
which should rank among the important contributions which 
have been made to this subject. 

In 1867^ Theophilus Parvin described an operation for 
uretero-vaginal fistula, a condition which had previously 
attracted little attention. This consisted in first turning 
the displaced distal extremity of the ureter into the bladder, 
and then closing the vaginal opening. The case reported 
was the first of this kind upon which the operator had 
essayed the method, and it proved entirely successful. 

In 1868* a valuable suggestion, illustrated by a case, was 

1 Trans. Obstet. Soc. London, vol. ii. p. 356. 

2 Bulletin N. Y. Acad. Med., vol. i. p. 410. 

3 Western Journ. of Med., vol. ii. p. 603. 

4 Am. Journ. of Med. Sciences, January, 1868, p. 91. 

22 



254 OBSTETRICS AND GYNECOLOGY. 

made by T. A. Emmet for the management of cases in which 
partial success attends reposition of an inverted uterus. This 
consisted in keeping the partially replaced body within the 
cervix by closing the os externum uteri by silver sutures. 
By this method the advance gained at one sitting is not 
lost, and the case is better prepared than it would otherwise 
be for further efforts. 

In 1869^ Julius F. Miner, of Buffalo, made a valuable 
contribution to the management of the pedicle of tumours 
removed by ovariotomy. His method consisted in stripping 
off from the tumour the expansion of the pedicle instead of 
ligating and severing it. In many cases Miner's method is 
of inestimable value, and allows of a successful issue to cases 
which would otherwise prove exceedingly difficult if not im- 
possible of management. 

J. Marion SimsMn the same year published an important 
essay entitled the " Microscope in Diagnosis and Treatment 
of Sterility." His observations bore especially upon the 
deleterious effects exerted upon the vitality of the zoosperms 
by ichorous discharges from the endometrium. Treatment, 
of course, was to be directed to the eradication of the disorder 
which gave rise to this devitalizing secretion. 

In 1870^ Gaillard Thomas performed the operation of 
vaginal ovariotomy, removing an ovarian cyst the size of a 
large orange through an opening made through the vagina 
and Douglas's pouch. This was the first time that this 
procedure was ever advised or practised for this purpose. 
His patient recovered. 

In 1872* R. Davis, of Wilkesbarre, Pa., in the same man- 
ner successfully removed an ovarian cyst weighing nine 
pounds. In rupturing adhesions, which were abundant, his 

• Buffalo Med. and Surg. Journ., June, 1869, p. 418. See also 
American Journ. Med. Sci., Oct. 1872, p. 391. 

2 N. Y. Med. Journ., January, 1869, p. 393. 

5 Amer. Journ. Med. Sciences, April, 1870, p. 387. 

* Trans. State Med. Soc. of Penua., 1874, p. 221. 



OBSTETRICS AND GYNECOLOGY. 255 

hand was passed high up into the peritoneal cavity, the sac 
extending several inches above the umbilicus, and forming 
a tumour about the size of a pregnant uterus at seven months 
of utero-gestation. His patient recovered. 

In 1873^ J. T. Gilraore, of Mobile, Ala , performed the 
same operation successfully. The temperature of his patient 
never rose to 100° F. 

In 1874'^ Robert Battey, of Atlanta, Ga., removed in the 
same way a cyst the size of a small orange. The patient 
rapidly recovered. 

By the same method, Battey has nine times extirpated the 
ovaries in pursuance of a plan which will now be mentioned, 
and Marion Sims has done so three times. 

In 1872 Robert Battey'' published an essay advocating 
extirpation of the ovaries with the intent of prematurely- 
inducing the menopause in cases in which menstrual ion is 
productive of very bad results. To use his own words, it 
is "an operation for the removal of the normal human 
ovaries, with a view to establish at once the ' change of life,' 
for the effectual remedy of certain otherwise incurable mala- 
dies." 

Too short a time has thus far elapsed for this bold inno- 
vation to have received its just estimate. It is not saying 
too much, however, even now to declare that its future will 
pr9bably be one of a great deal of usefulness when it has 
been circumscribed by proper limits and the class of cases 
to which it is appropriate has been clearly defined. Thus 
far Battey's operation has been practised in the United 
States 

by Robert Battey 10 times. 8 recoveries. 2 deaths. 
" Marion Sims 5 " 4 " 1 

" Gaillard Thomas 1 " i '' " 

1 N. 0. Med. and Surg. Journ., Nov. 1873, p. 341. 

2 Personal communication. 

3 Atlanta Med. and Surg. Journ., Sept. 1872, p. 321 



256 OBSTETRICS AND GYNECOLOGY. 

Battey^ thus expresses himself concerning some of the im- 
portant points connected with this subject: — 

" I have operated in widely difiFerent circumstances. In one 
case the patient had amenorrhcea, convulsions, recurrent hema- 
tocele, repeated pelvic abscesses, incipient tuberculosis from pul- 
monary congestions, etc. Several of the cases passed under the 
head of ovarian neuralgia; several had intractable dysmenorrhoea 
with pelvic deposits of old lymph ; one had ovarian insanity, etc. 
All had exhausted the available resources of the art to no useful 
purpose. / operate upon no case that any otlier respectable 
medical man proposes to cure. In most of my cases the full 
results of the menopause have not yet been developed. This is 
the work of many months, and sometimes two or three years 
are necessary to its full and perfect realization. In no case has 
the patient failed to realize such a degree of relief and benefit 
following the operation as to amply compensate her for all the 
pains and dangers incident thereto, to say nothing of the promise 
of full and ample recovery at the completion of the physiological 
' change.' In two of my cases this change has seemed to occur 
at once in all its completeness ; but it is always my expectation 
that it will occur gradually, and extending through two or even 
three years to its final completion. In my first case (now three 
years ago) the restoration to health is eminently satisfactory. It 
is true that she is not absolutely and perfectly well, but she is 
fully relieved of the convulsions, the violent periodical conges- 
tions, the hematoceles, the pelvic abscesses, etc., for which I 
operated. I submit to you the question in all sincerity, if I con- 
fine myself to cases where life is endangered, or where health and 
happiness are destroyed — cases which are utterly hopeless of 
other remedy this side the grave — ought the profession to demand 
at my hands the restoration of these forlorn invalids to a state 
of complete and absolute health in every particular ?" 

In ISTS'^ John Ball, of Brooklyn, published the results of 
a plan of treating constrictions and tortuosities of the canal 
of the cervix uteri resulting from versions and flexions, by 

1 Amer. Practitioner, Oct. 1S75, p. 207. 

2 N. Y. Med. Jouru., Oct. 1873, p. 363. 



OBSTETRICS AND GYNECOLOGY. 257 

rapid dilatation, by expanding instruments of steel. Ellin- 
ger, of Germany, lias likewise adopted this heroic method, 
but Ball declares that he has employed it for several years, 
and without the knowledge that any one else was testing it. 
The procedure is thus described by its originator : — 

" My method of procedure is first to evacuate the bowels pretty 
thoroughly beforehand, so as to prevent all effort in that direction 
for two or three days ; I then place the patient upon her back, 
with her hips near the edge of the bed, and, when she is pro- 
foundly under the influence of an anaesthetic, I commence by 
introducing a three bladed, self-retaining speculum, which brings 
in view the os uteii, which I seize with a double-hooked tenacu- 
lum, and draw down toward the vulva, when I first introduce a 
metal bougie as large as the canal will admit, followed in rapid 
succespion by others of larger size until I reach No. 7, which 
represents the size of my dilator. I then introduce the dilator, 
and stretch the cervix in every direction, until it is enlarged 
sufficiently to admit a No. 16 bougie, which is all that is gene- 
rally necessary. Then I introduce a hollow, gum-elastic uterine 
pessary, of about that size, and retain it in position by a stem, 
secured outside of the vulva, for about a week, in which time it 
has done its work, and is ready to be removed. 

"During this time I keep the patient perfectly quiet, and 
usually upon her back, which is generally found to be the most 
comfortable position." 

To the uninitfated this procedure appears fraught with 
great danger, but the originator declares that out of be- 
tween twenty and thirty cases he has met with but one fatal 
issue. He says : — 

" According to my own experience, it causes much less con- 
stitutional disturbance than the use of tents ; and I think it 
safer even than the metrotome, and free from some serious objec- 
tions to the use of the latter ; as, for instance, when incisions are 
made through the tissues of the cervix, unless carried deep 
enough to prevent reunion, they must of necessity form a cica- 
trix, which will interfere, more or less, with the dilatation of the 
parts. And, when the operation does not succeed, the patient 

9.9* 



9:^ 



OBSTETRICS AND GYNECOLOGY. 



is left in a worse condition than before; while, in the rapid and 
forcible dilatation of the cervix, there is no sacrifice of the integ- 
rity of the parts, and, being done under the influence of an anaes- 
thetic, there is no shock of the nervous system, and generally 
but little subsequent suffering." 

In 18Y4 an important contribution to the pathology and 
treatment of diseases of the cervix uteri emanated from T. 
A. Emmet/ It had long been known, that, as the head of 
the child passed the os externum uteri, lacerations of its 
mitscular walls often occurred ; but up to this time it had 
not been recognized how uniformly this condition is con- 
founded with the so-called ulceration of the cervix, and how 
commonly the eversion of the lips of the cervix resulting 
from it is mistaken for hypertrophy of the cervical tissues. 
Emmet advocated for this condition vivification of the edges 
of the lacerated parts, and approximation of them by suture. 
This procedure is one of most beneficent character, and one 
which must take rank as an important advance in gynaeco- 
logical surgery. 

The medical literature of the first quarter of the present 
century contains several allusions to an operation styled 
gastro-elytrotomy, a procedure intended to avoid cutting 
through the uterus and peritoneum, and yet allowing of the 
removal of the child through the abdomina] walls and above 
the true pelvis. 

This operation has attracted the attention of four obstet- 
ricians : Jorg in 1806, Ritgen in 1820, Physick in 1822, 
and A. Baudelocque in 1823. Kilian, in speaking of Jorg's 
conception of the operation, says that he merely suggested 
it; and even if he had performed it, his results would not 
have been admitted in a fair appreciation of the operation, 
since he did not propose avoiding the peritoneum, a promi- 
nent feature of the method. The same writer alludes to 

1 N. Y. Med. Journ., Julv, 1874. 



OBSTETRICS AND GYNECOLOGY. 259 

one operation by Ritgen which ended fatally. In 18Y0, 
Gaillard Thomas, without a knowledge of the fact that he 
had been anticipated in the procedure, delivered in this way 
a living child. The operation was at that time thus de- 
scribed by him: — ^ 

" The patient being placed upon a table, anaesthesia was pro- 
duced, so as to quiet her restlessness and jactitation, with a few 
inhalations of ether. I then passed my hand up the vagina and 
dilated the cervix slowly and cautiously, so that at a three- 
qnarter distention no injury was done to its tissue. With a 
bistoury I then cut through the abdominal muscles, the incision 
being carried from the spine of the pubis to the anterior supe- 
rior spinous process of the ileum. The lips of the wound were 
now separated, and by two fingers the peritoneum was lifted 
with great readiness, so that the vagino-uterine junction was 
reached. The vagina was now lifted by a steel sound passed 
within it, and cut, and the opening thus made was enlarged by 
the fingers. The cervix was then lifted into the right iliac fossa 
by the blunt hook, while the fundus was depressed in an oppo- 
site direction. I then passed my right hand into the iliac fossa, 
and introduced two fingers into the uterus, while the left hand, 
placed on the outer surface of the uterus, depressed the pelvic 
extremity of the foetal ovoid. The knee was readily seized, and 
delivery easily and rapidly accomplished." 

In 1876,^ Alexander J. C. Skene, of Brooklyn, per- 
formed this operation with a brilliancy of result never before 
attained by any one. The patient was a small rachitic 
woman, aged thirty-one years, who had been three times 
delivered, once by craniotomy and twice by premature de- 
livery at the seventh and eighth months. One of the last 
two children had lived a few minutes, and one for several 
months. In her fourth pregnancy Dr. Skene let gestation 
advance to full term; then, finding an arm and the cord 

* Amer. Journ. Obstet., vol. iii. p. 125. 
2 Ibid., vol. viii. p. 636. 



260 OBSTETRICS AND GYNAECOLOGY. 

presenting, he performed gastro-elytrotomy, saving tlie 
mother and a vigorous child weighing ten pounds. Both 
made a perfect recovery. 

This completes the list of those contributions to obstet- 
rics and gynaecology on the part of this country wliich 
appear to be especially marked by originality and by prac- 
tical utility. But how diflRcult is it to decide what really 
deserves the credit of original conception ? "Is there any- 
thing whereof it may be said — See, this is new ? it hath 
been already of old time which was before us. There is no 
remembrance of former things." As the husbandman turns 
up to the light and brings into activity and usefulness the 
mould which, though buried for ages, was in by-gone times 
ploughed by his predecessors, so do the seekers after new 
ideas bring to light the thoughts of those whose discoveries 
have been long ago forgotten. Who is to decide how long 
a time must intervene between the periods of successive 
discovery to warrant for the latest aspirant the claim of 
originality ? 

The peculiar features of the contributions just enume- 
rated seem to warrant their arrangement in a special cate- 
gory, but this does not argue in them greater value than 
that attaching to those of somewhat different character 
which come to be considered now. Indeed, some of the 
latter type hnve exerted a more powerful and widespread 
influence than many of the former, and have been produc- 
tive of greater good to medicine and humanity. 

In June, 1842, Jos. Warrington's "Obstetric Cate- 
chism" which for a time was used as an epitome of the 
subject of midwifery by students, appeared. 

The year 1843 was marked by the appearance of an 
essay^ which was productive of a great deal of good, from 

' New England Quarterly Journ. of Med. and Surg., April, 1843, 
p. 503. 



OBSTETRICS AND GYNECOLOGY. 261 

tlie pen of the eminent poet-physieian, Oliver Wendell 
Holmes. At that period the then authoritative works upon 
obstetrics, those of Dewees and Meigs, both maintained the 
non-contagiousness of puerperal fever. Holmes boldly 
joined issue upon this momentous point, and, although de- 
voting much less attention to this department than the 
authors mentioned, his observations led him to a more 
correct conclusion. 

In 1845 an important contribution to a subject which 
even now has received little attention, was made by Isaac 
E. Taylor, of Xew York, in an essay upon Rheumatism of 
Uterus and Ovaries.^ In this some striking cases of 
rheumatic disorder of the muscular structure of the pregnant 
uterus were recorded. 

During this year W. L. Atlee published a synopsis^ of 
101 ovariotomies, and an essay upon Intra-Uteriue Fi- 
broids.^ 

During the next year an essay appeared from Samuel 
Kneeland, Jr.,* of Boston, maintaining a close relationship 
between epidemic erysipelas and puerperal fever. It is 
well known how much favour this view has since met with. 

The year 1846 was marked by a discovery in this country 
which may be said to overshadow any other of its contri- 
butions to medicine. I allude to anaesthesia, discovered 
by Horace Wells, a dentist of Connecticut, and subse- 
quently made practicable and useful by W. T. G. Morton, 
likewise a dentist, of Boston. Only the relations of this 
subject to obstetrics and gyneecology find legitimate place 
in this essay. 

In January, 184t, anaesthesia by ether was first employed 
for assuaging the pains of labour by Prof. Simpson, of 

• Amer. Journ. Med. Sci., July, 1845, p. 45. 

2 Ibid., April, 1845, p. 309. 

3 Trans. Amer. Med. Assoc, vol. iii. p. 380. 

* Amer. Journ. Med. Sci., April, 1846, p. 324. 



262 OBSTETRICS AND GYNAECOLOGY. 

Edinburgh ; in April of the same year it was employed in 
this country, by Dr. N. C. Keep, of Boston ; and in May, 
by Dr. Channing, of Boston, in a case of instrumental 
labour. The introduction of this beneficent agent into the 
lying-in chamber constitutes an era in the history of ob- 
stetrics. It is somewhat singular that after the discovery 
of anaBSthesia in this country ; after tlie prediction, long 
before its discovery, by one of America's greatest physi- 
cians, that^ " a medicine would be discovered that should 
suspend sensibility altogether, and leave irritability, or the 
powers of motion, unimpaired, and thereby destroy labour- 
pains altogether;" after it had been enij^loyed here in 
hundreds of cases for surgical operations, this link of the 
chain should have been forged by a European. Yet such 
was the case, and far be it from any American to begrudge 
him one atom of the glory which he deserves, or to endea- 
vour to dim its lustre by "faint praise." 

Boston was the field in which the first demonstrations of 
anaesthesia, as an agent of practical value, were made, and 
there appeared the first and most ardent advocate of its 
use in obstetrics in this country. Br. Walter Channing 
was elected to the chair of obstetrics in Harvard, in 1833, 
and was recognized as a leader in this department, both 
from his teachings and writings. He warmly espoused the 
subject, and in 1848 published a treatise on Etherization in 
Childbirth, illustrated by 581 cases. This volume numbers 
400 pages, and served to bring the subject fully before the 
whole civilized world. So well did it serve its purpose 
that no similar work has since appeared either from an 
American or European author. 

What a striking contrast is presented between the rapid 
acceptance of this discovery by the whole medical world and 
the tardy, unwilling, bitter reception of ovariotomy 1 The 

• Rush, Med. Inquiries and Observatious, 3d ed., vol. iv. p. 376. 



OBSTETRICS AND GYNECOLOGY. 263 

first patient in Boston submitted to operation under anaes- 
thesia, was etherized by Morton in October, 1846. Writing 
in April, 1847, Hayward declares that ether "has probably 
been used in this way by several thousand individuals in 
this city within the last six months," and, in 1848, Chan- 
ning,^ of the same city, illustrates the utility of this agent 
in the lying-in chamber alone by the citation of over five 
hundred cases. 

In 1847, I. E. Taylor contributed an essay drawing 
attention to the causation of exophthalmos and enlarge- 
ment of the thyroid gland by excessive lactation ; and 
Fordyce Barker one upon diseased states of the uterine 
neck. 

In 1850 the first attempt at the establishment of an 
obstetric clinic in this country was made by J. P. White, of 
Buffalo. In furtherance of this mode of instruction, the 
act of human parturition was displayed ocularly to some 
sixteen students, the professor explaining its features during 
its accomplishment. A perfect storm of popular, and to a 
certain extent of professional indignation, was excited by 
this, which was only stemmed by the dignified and bold 
attitude of the united faculty of the University of Buffalo, 
and the support lent by enlightened obstetricians though- 
out the land. 

The whole subject was fully brought out in the. trial of 
the People v. Dr. H. N. Loomis, a report^ of which to-day 
constitutes a curious episode in the medical literature of 
the century. In this will be found a letter signed by 
seventeen physicians, characterizing the demonstration as 
"wholly unnecessary, and grossly offensive, alike to morality 
and common decency." 

1 Etherization in Childbed, Boston, 1848. 

2 Jewett, Thomas & Co., Buffalo, 1850. 



264 OBSTETRICS AND GYNECOLOGY. 

Daring the next year a fall synopsis^ of all the known 
cases of ovariotomy which had up to that time been per- 
formed appeared from W. L. Atlee. This embodied 222 
cases, and constituted the most valuable statistical table 
which had yet appeared. 

In the same year a masterly essay upon the Corpus 
Luteum of Menstruation and Pregnancy'^ was submitted to 
the American Medical Association, and was awarded the 
prize. Its author was John C. Dalton, of New York. 

In 1853 Thomas F. Cock published a Manual of Ob- 
stetrics,^ a multum in parvo o{ the most reliable maxims in 
that art, which even now constitutes the vade mecum of 
many of our students. 

Two years afterwards a paper* was read by Fordyce 
Barker before the New York Academy of Medicine upon 
the Treatment of Puerperal Convulsions, which fully pre- 
sented all that w^as then known upon a subject which has 
since called forth so much discussion. In the same year 
R, A. F. Penrose published an interesting and valuable 
essay upon a Case of Triplets, with the Mechanism of 
Labour.^ 

In the same year James Deane, of Massachusetts, pub- 
lished an essay upon " The Hygienic Condition of the 
Survivors of Ovariotomy," which was particularly valuable 
at a time when this operation was being weighed in the 
balance and its beneficent results doubted by many of the 
most sincere investigators. 

In 1856^ there appeared the most exhaustive and valua- 
ble essay upon ovariotomy which had yet been published. 
This was the prize essay of Geo. H. Lyman, of Boston, 

1 Trans. Amer. Med. Assoc, vol. iv. p. 286. 

2 Ibid., p. 547. 3 w. Wood & Co., N. Y. 

* Transactions, vol. i. p. 273. ^ Med. Exam., Feb. 1855, p. 77. 
6 Publications of Mass. Med. Soc, May, 1865. 



OBSTETRICS AND GYNAECOLOGY 2C5 

entitled, " History and Statistics of Ovariotomy, and the 
Circnmstances under which this Operation may be re- 
garded as Safe and Expedient." It appeared at a most 
opportune moment, and, characterized as it was by a fair 
and manly spirit, a remarkable degree of accuracy, and 
entire absence of narrow and prejudiced views, it did a 
great deal of good in reference to the important subject 
with which it dealt. Although twenty years have elapsed 
since its publication, it can still be read with profit and be 
regarded as a safe guide in reference to many essential 
points. 

During the years 1848 and 1856 there appeared in the 
American Journal of the Medical Sciences^ some very valua- 
ble essays of statistical character upon rupture of the 
uterus by J. D. Trask, of Astoria, Long Island. These 
were valuable by the faithfulness and accuracy which char- 
acterized them, and the thoroughness with which the subject 
was treated. The same author has now nearly ready for 
publication a paper bringing the subject down to the pre- 
sent day. 

In the latter of these years I. E. Taylor, in a report of 
Two Cases of Recto-Yaginal Fistula, cured by a New 
Operation,"^ advocated severance of the sphincter ani in 
such cases after the manner of Rhea Barton. During the 
succeeding year two valuable papers appeared, one by Emil 
Noeggerath upon Metastatic After-Pains,^ and another by 
J. Marion Sims, upon Silver Sutures in Surgery.* 

In 1858 J. Foster Jenkins,^ of Yonkers, made an im- 
portant contribution to the literature of the subject of spon- 
taneous umbilical hemorrhage in the newly born, and William 

• N. S., vol. XV. pp. 104 and 383, aud xxxii. p. 81. 
2 N. Y. Med. Jouru. 3 n. y. -Journ. Med., Maj, 1857, p. 287. 

^ Trans. N. Y. Acad. Med., Nov. 1857. 
5 Trans. Amer. Med. Assoc, vol. xi. p. 263. 
23 



266 OBSTETRICS AND GYNECOLOGY. 

Read, of Boston, one npon the influence of tlie Placenta 
upon the Development of the Uterns during Preo:nancy.^ 

During the following year three essays well worthy of 
note appeared; two by Xoeggerath, npon the Local Disin- 
fecting Treatment of the Cavity of" the Uterns for the 
Treatment of Puerperal Fever, ^ and on the Operation of 
Turning by External Manipulations f one by Sims upon 
Amputation of the Cervix, Stump covered with Vaginal 
Membrane.* 

In 1861 William Read published a paper^ upon The 
Formation of Knots in the Umbilical Cord, and Fordyce 
Barker^ one on the Use of Anaesthetics in Midwifery. 
The latter of the subjects was one requiring at that time all 
the light which could be shed upon it by conscientious 
observers. 

In this year there appeared^ an interesting paper by 
Samuel Ft. Percy, of N. Y., demonstrating the tenacity of 
vitality possessed by the human zoosperm. His statements 
are here given in his own words : — 

" I was called to attend a lady with uterine disease, but I con- 
sidered it best to postpone all treatment, as on the next week 
her husband would leave home to be absent two or three 
months. On the Monday following he left, but she did not call 
upon me until a week from the day following. On examination 
with the speculum I found a mass of what I supposed to be 
rauco-purulent matter, proceeding from the os uteri. Wishing 
to ascertain its character, I examined it with the microscope, 
and was surprised to find that it was semen, and that it con- 

1 Am. Journ. Med. Scieuce, April, 1^58, p. 309. 

2 Contrib. to Midwifery and Dis. of Women, New York, 1859. 

3 N. Y. Journ. of Med., Nov. 1859, p. 329. 

1 Trans. N. Y. State Med. Society, 1861, p. 3G7. 

5 Am. Journ. Med. Sci., Oct. 1861, p. 381. 

6 Trans. N. Y. Acad. Med., vol. ii. p. 251. 

7 Amer. Med. Times, March, 1861, p. 160. 



OBSTETRICS AND GYNAECOLOGY. 207 

tained living spermatozoa and many dead ones. Communicating 
in a proper way my discovery, I questioned her as to the time of 
her last intercourse with her husband. It was on the Monday 
morning before leaving, nearly eight and a half days previous. 
I would stake my reputation on her honour." Dr. Percy fur- 
ther says: "Knowing that the zoosperms of the frog are fre- 
quently found living days after the frog's death, and even when 
it has been frozen, I can conceive no reason why human sperma- 
tozoa may not retain their vitality for some time, especially 
when protected by warmth and placed in the situation where 
nature designed them. But to test this matter, T placed some 
semen in the lower part of a piece of moistened membrane, 
tied it, and placed it within the vagina of a mongrel bitch. 
Upon removing it, upon the sixth day, most of the zoosperms 
were possessed of vitality, though there were many dead ones. 
These facts may have an important bearing in a medico-legal 
way." 

During the next year the subject of Pelvic Haematoccle 
began to attract considerable attention in America. From 
the year 1831, in which it was first described by Recatnier, 
cf Paris, it had not ceased to attract considerable attention 
in France, and between that period and 1858 Bernntz, 
Yignes, Nelaton, Gallard, and Voisin had written their 
well-known essays upon it. Up to this year, however, only 
one case had been reported amongst us, and it constituted 
an era in the subject for three essays to appear in one 
year. One was by John Byrne, of Brooklyn ; one by For- 
dyce Barker ; and one by E. Noeggerath. All these were 
read before the N. Y. Academy of Medicine, and ap- 
peared in its Transactions. 

During this year I. E. Taylor published a valuable essay^ 
upon the non-shortening of the supra and infra-vaginal 
portion of the cervix uteri up to the full term of gestation. 
In this the author contested the views of Stoltz, of Stras- 

' Am. Med. Times, vol. iv. p. 342. 



268 OBSTETRICS AXD G Y N.i:COLOG Y. 

bourg, to the effect that gradual expansion of the cervical 
canal during the latter months of pregnancy effaced or 
obliterated that portion of the uterus. 

In 1863, H. R. Storer,^ of Boston, added to the literature 
of the subject of anaesthesia in midwifery and medical sur- 
gery an essay of considerable value ; Barker one upon Al- 
buminuria'- as affecting Pregnancy, Parturition, and the 
Puerperal State; and E. X. Chapman a report^ entitled a 
Selection of Remarkable Cases. 

The next year saw the publication of two able papers 
upon Ovarian Tumours and Ovariotomy,* by E. R. Peaslee; 
an essay upon Spinal Irritation/ by Charles F. Taylor; 
and an excellent treatise upon Chronic Inflammation and 
Displacement of the TJnimpregnated Uterus, by W. H- 
Byford, of Chicago. 

In 1S65, T. A. Emmet published upon the Treatment 
of Dysmenorrhoea and Sterility,^ resulting from Anteflexion 
of the Uterus, and upon the Radical Operation for Proce- 
dentia;' I. E. Taylor upon Placenta Prcevia;^ and Peas- 
lee^ gave Statistics of 150 Cases of Ovariotomy. 

The work of Byford, mentioned as having appeared in 
1864, had already met with so brilliant a success that it now 
reappeared, enlarged and improved, under the title of the 
Medical and Surgical Treatment of Women. 

During the next year, I. E. Taylor^*^ reported sixty cases 

1 Boston Med. and Surg. .Jouru., vol. Ixix. p. 249. 

2 Bulletin N. Y. Acad. Med., vol. ii. pp. 36 and 67. 

3 Med. and Snrg. Reporter, Pliila. . 

* Bull. N. Y. Acad. Med., vol. ii. p. 226. 

5 Trans. N. Y. State Med. Soc, 1S64, p. 126. 

6 New York Med. Jouru., June, 1S65, p. 205. 

7 Ibid,, April, 1865, p. 1. 

8 Trans. N. Y. State Med. Soc, 1865, p. 62. 
8 Am. Journ. Med. Sci., Jan. 1865, p. 89. 

»o Trans. N. Y. State Med. Soc, 1866, p. 97. 



OBSTETRICS AND GYNECOLOGY. 269 

of recto-vaginal and recto-labial fistnloe treated by the plan 
already mentioned, and Emmet^ published an essay upon 
Atresia Yaginse. 

This year was specially marked by the appearance of a 
work which more profoundly aroused the gyneecologists of 
Europe, as well as of America, than any other which had 
appeared since those of Bennet and Simpson. This was a 
work entitled Clinical Notes on Uterine Surgery, by J. 
Marion Sims. The clear, forcible, and persuasive style of 
this work, the record of successful operations which it con- 
tained, and the stamp of earnest and original thought which 
it bore upon every page, served to give it a circulation 
which demanded its translation into almost all the modern 
languages of Europe, and to make it an essential in the 
library of every progressive gynaecologist. Ten years have 
elapsed since its publication, and yet it may safely be stated 
that no work now extant constitutes a more perfect guide 
to the gynaecological surgeon. 

In this year appeared, too, an excellent treatise of over 
fifty pages upon Vesico-vaginal Fistula, by M. Schnppert, 
of New Orleans. This contained an exhaustive resume of 
the history of the operation, was fully illustrated, and em- 
bodied the extensive experience of one who has made him- 
self well known as a successful operator in this field of 
surgery. 

In this year, also, especial attention was called to the 
subject of extirpation of the uterus for fibroids, by the 
publication of a successful case, by H. R. Storer,^ in which 
this organ and both ovaries were removed. This grave 
procedure, recommended, but never practised, as early as 
1787, by Wrisberg, was in the present century performed 
by Clay, of Manchester, and Kceberle, of Strasbourg. In 

1 Richmond Med. Jonrn., Ang. 1866, p. 89. 

2 Am. JourD. Med. Sci., Jan. 1866, p. 110. 



270 OBSTETRICS AND GYNAECOLOGY. 

1854, the first operation was performed in this country for 
tliis purpose, by Kimball,^ of Lowell, the tumour weighing 
six pounds, and the patient recovering. He has been fol- 
lowed by Burnhani, Cutter, Peaslee, Darby, Sims, Atlee, 
Wood, Sands, Buckingham, Storer, Hackenberg, Weber, 
Thomas, Chadwick, and others. The statistics of the proce- 
dure in this country have not been collected, but it is safe to 
say that no such results can be reported as have recently 
come to us from Paris, where M. Pean has met with a suc- 
cess of seven out of nine, or an equivalent of seventy-eight 
out of one hundred. Kimball has thus far performed ten 
operations, with four recoveries atid six deaths. In New 
York cit^ the operation has been repeatedly performed, but 
never yet with a favourable issue. 

l!i 1867, Dr. E. D. Miller,' of Boston, published an essay 
introducing into practice the scarification of the lining 
membrane of the body of the uterus, and described an in- 
strument for performing this operation ; and a valuable 
paper was read before the American Medical Association 
by Stephen Rogers,^ of New York, advocating gastrotomy 
after rupture of the cyst of extra-uterine pregnancy, for the 
purpose of ligating bleeding vessels, and thus giving the 
patient a chance for life. As early as 1849 this course had 
been suggested by W. AV. Harbert in the Western Journal 
of Medicine and Surgery; but to Rogers belongs the credit 
of pressing the claims of the idea upon the profession in a 
way to attract to it the grave attention which it deserves. 

Montrose A. Pallen, formerly of St. Louis, now of New 
York, read in the same year an interesting paper on the 
Treatment of Certain Uterine Abnormities, before the Ameri- 
can Medical Association, and published a Resume^ of forty- 

1 Bost. Med. and Surg. Journ., May, 1855, p. 249. 

2 Ibid., March, p. 133. 

3 Trans. Am. Med. Assoc. 1867, vol. xviii. p. 85. 
^ Humboldt, Med. Archives, 1867. vol. i. p. 7. 



OBSTETRICS AND GYNECOLOGY. 271 

six operations for djsraenorrhoea by tlie division of the 
cervix uteri. 

Wm. T. Lnsk^ also made a contribution entitled Uraemia, 
a Common Cause of Death in Uterine Cancer. 

In this year H. Lenox Hodge, ^ in a case of tubo-uterine 
pregnancy, performed a very remarkable and successful 
operation for removal of the foetus. The pregnancy had 
advanced to the eighth month, and a thin septum divided 
the true and unoccupied uterus from the adjoining vicarious 
one so as to prevent delivery. Hodge cut through this, 
and delivered the child ^Je?- vias naturales. The child lived 
about ten hours, and the mother recovered. 

In 1868 the first journal ever devoted especially to the 
interest of obstetrics and gynaecology in America appeared 
in New York. The establishment and early maintenance of 
this excellent quarterly, styled The American Journal of 
Obstetrics and Diseases of Women and Children, were en- 
tirely the results of the energy and enterprise of a single 
member of the profession, B. F. Dawson. After eight years 
of existence it has established its right to be considered one 
of the most valuable periodicals of the country, and under 
its present editor, Paul F. Munde, fully maintains its posi- 
tion. 

During this year there appeared three works in this de- 
partment of medicine ; first, the Obstetric Clinic of George 
T. Elliot, classic in style, and replete with the wise counsels 
of a master in the obstetric art ; second, a Treatise upon 
Yesico-vaginal and Recto-vaginal Fistulas, by T. A. Em- 
met ; and third, a Practical Treatise upon the Diseases of 
Women, by Gaillard Thomas. 

Two good papers likewise appeared, one upon Intra- 

1 N. Y. Med. .Journ., .Juue, 1867, p. 205. 

2 Parry, op. cit. p. 266. 



272 OBSTETRICS AND GYNAECOLOGY. 

uterine Injections, by M. A. Fallen/ and one upon the 
Treatment of tlie Ui'osniic Convulsions of Pregnancy by 
Morphia, by F. D. Lente."^ 

In 1868, II. R. Storer,^ of Boston, advocated inclosing 
the pedicles of ovarian tumours in the abdominal walls. 
This method, which he styled " pocketing the pedicle," con- 
sisted of fixing it in the abdominal opening and completely 
covering it by the cutaneous tissues. 

The year 1869 was rich in essays of considerable value. 
Chief among these may be mentioned one upon Ovariocen- 
tesis Vaginalis,* and another upon Chronic Metritis in its 
relation to Malignant Disease of the Uterus, by Noeggerath ; 
one by Wm. Goodell,^ of Philadelphia, upon Concealed Ac- 
cidental Hemorrhage of the Gravid Womb ; one upon the 
Surgery of the Cervix in connection with the treatment of 
certain Uterine Diseases, by T. A. Emmet;^ one upon Hypo- 
dermic use of Ergot in Post-partum Hemorrhage, by F. D. 
Lente •/ one upon Face Presentations, by I. E. Taylor f one 
upan Intra-uterine Injections, by Joseph Kammerer;^ one 
by J. G. Pinkliam,^° of Lynn, on Scarification of the Fundus 
Uteri in Chronic Metritis and Endometritis, which had been 
previously advised by Miller ; one by H. R. Storer^^ upon a 
Method of Exploring and Operating upon the Female Rec- 
tum by Elversion of the Anterior Rectal Wall by a finger in 

• St. Louis Med. and Surg. Jouru., July, ISGS, p. 294. 

2 Med. Record, April 15. 

3 Ibid., Jan. 15, 1S68, p. 519. 

* Amer. Journ. Obstetrics, May and November. 

5 Ibid., vol. ii. pp. 1, 505, and 610. 

6 Ibid., February, 1869, p. 339. 

7 N. Y. Med. Record, vol. iv. p. 411. 

8 N. Y. Med. Journ., November, 18U9, p. 125. 
3 Read before Co. Med. Soc. 

10 Journal Gynaecological Society, Boston, vol. i. p. 23. 
'= Ibid., vol. i. p. 24. 



OBSTETRICS AND GYNECOLOGY. 273 

tlie Yagina; and one upon the Pathological Sympathies of 
the Uterus, by Y. A. Taliaffero,' of Ga. 

The literature of fibro-cystic tumour of the uterus is very 
recent. In 1869 Koeberle, of Strasbourg, tells us that only 
fourteen cases had been recorded, and of these two were 
discovered post-mortem. In that year C. C. Lee,^ of New 
York, collected nineteen cases, and published them in an 
interesting paper. 

In the same year^ Gaillard Thomas published the account 
of a case of inversion successfully reduced by dilatation of 
the constricting neck through an opening in the abdomen 
made by section through its walls. This procedure has not 
met with favour, and has not since that time been repeated 
by any one but its author. 

During this year a society, which exerted considerable 
influence in arousing attention to the subject of Gynaecology 
in New England, was formed in Boston, chiefly through the 
exertions of Horatio R. Storer, and called the Gynaecological 
Society of Boston. Before the year had expired a journal 
emanated from this society styled the Journal of the Gynae- 
cological Society of Boston. It now no longer exists, but 
during its period of publication it exercised a decided influ- 
ence in this department of medicine. 

Societies devoted to obstetrics and gynaecology have like- 
wise been established in Louisville, Philadelphia, and New 
York. They are still in active operation, and furnish in 
their proceedings and reports a valuable fund of information 
to the general reader of the medical periodicals of the 
country. 

We now arrive at the commencement of the present de- 
cade, and during the six years of it which have now expired, 

' Journ. Gynsec. Soc. Bost., vol. i. p. 341. 

^ Med. Record, vol. iv. p. 495. 

3 Amer. Jouin. Obstetrics, November, 1869, p. 423. 



2Y4 OBSTETRICS AND GYN.5:C0L0GY . 

SO numerous have been the contributions to tin's depiirtment, 
tliat only a small proportion, consisting of the most valuable, 
can be noticed. During the first year of this period, there 
appeared Byford's Treatise on the Theory and Practice of 
Obstetrics, the first systematic work upon this subject which 
had appeared since that of Bedford, which is elsewhere 
noticed. An excellent paper likewise appeared from C. C. 
P. CI ark, ^ of Oswego, upon the Management of the Ob- 
stetric Forceps, replete with the sagacious observations of 
an original and candid observer; and an important essay 
upon Anal Fissure in Women, by H. R. Storer.^ 

The next year produced a carefully prepared and interest- 
ing essay by Wm. Goodell,^ entitled A Critical Inquiry into 
the Management of the Perineum during I^abour ; one of 
great practical value by the late John S. Parry* upon Sud- 
den Enlargement of Ovarian Cysts from Hemorrhage into 
them; one upon Dysmenorrhoea and its Treatment by M. 
A. Fallen ;^ a report of a Case of Simultaneous Intra- and 
Extra-uterine Pregnancy going to Full Term, by S. Pol- 
lak ;° a paper upon ]\Iechanical Treatment of Displacement 
of Unimpregnated Uterus, by George Pepper, of Philadel- 
phia ;^ a very valuable essay upon' Placental Extraction and 
Placental Expression, by Parvin f and an equally valuable 
one by Nathan Bozeman^ upon Urethrocele, Catarrh, and 
Ulceration of the Bladder in Females. 

The next year was marked by the appearance of three 

• Trans. N. Y. State Med. Soc, 1870, p. 249. 

2 .Journal Gynsecological Society, Boston, vol. ii. p. 221. 

3 Amer. Journ. Med. Sci , Jan. 1871, p. 53. 

4 Amer. Journ. Obstetrics, Nov. 1871, p. 454. 
& Missouri Med. and Surg. Report. 

6 St. Louis Med. and Surg. Journal, May, 1871, p. 193. 

7 Amer. Journ. Obstetrics, Aug. 1871, p. 258. 

8 Trans. lud. State Med. Soc, 1871, p. 11. 

9 Amer. Journal Obstetrics, Feb. 1871, p. 63ti. 



OBSTETRICS AND GYNECOLOGY, 275 

works devoted to this department of medicine ; first, one 
upon Ovarian Tumours, their Patliology, Diagnosis, and 
Treatment, by E. R. Pcaslee ; second, one upon Hyster- 
ology, by E. N. Chapman ; and third, one upon Electro- 
cautery in Uterine Surgery, by John Byrne. The first of 
these is certainly the most systematic and complete treatise 
which has thus far appeared upon this subject, and the last, 
although small in dimensions, deals exhaustively with the 
important matter upon which it touches. 

During this year there appeared a remarkable essay upon 
Latent Gonorrhoea in Females, by Noeggerath. In this the 
author strongly assumes the position which is here an- 
nounced in his own words.^ 

" I have undertaken to show that the wife of every husband 
who, at any time of his life before marriage, has contracted a 
gonorrhoea, with very few exceptions, is affected with latent 
gonorrhcEa, which sooner or later brings its existence into view 
through some one of the forms of disease about to be described. 
. . . . I believe I do not go too far when I assert that, of 
every 100 wives who marry husbands who have previously had 
gonorrhoea, scarcely 10 remain healthy ; the rest suffer from it 
or some other of the diseases which it is the task of this paper 
to describe. And, of the ten that are spared, we can positively 
affirm that in some of them, through "some accidental cause, the 
hidden mischief will sooner or later develop itself." 

The disorders supposed by the author to result from 
latent gonorrhoea are perimetric inflammations, both acute 
and chronic ; ovaritis ; and catarrh of the genital tract. 

In the same year Parry^ published an essay upon the com- 
parative merits of craniotomy and Cesarean section in pelves 
with a conjugate diameter of 2^ inches or less. 

The idea of draining the peritoneal cavity by creating an 
opening per vaginam into its most dependent portion, the 

' Published in Bonn. 

2 Amer. Jouru. Obstet., Feb. 1873, p. 644. 



276 OBSTETRICS AND GYNECOLOGY. 

pouch of Douglas, has often presented itself to the minds 
of ovariotomists. As early as 1855^ the practice was 
adopted by Peaslee, and subsequently by Kimball, of 
Lowell ; W. W. Green and Tewkesbury, of Portland ; Miner, 
of Buffalo; Thomas, of New York, and others. This plan 
of accomplishing drainage of the peritoneal sac has by no 
means met with general approval or adoption. Nor is it 
probable that it will ever do so, for between the perito. 
neum and vagina there is an interspace which is filled by 
areolar and adipose tissue into which an escape of putrid 
fluid must often enter and from which it would readily be 
absorbed. 

In 1872 Marion Siras^ revived the method and bypassing 
into the peritoneum, through the vagina, tubes of small 
calibre admitting of perfect drainage, and the use of disin- 
fectant injections he hoped to overcome more perfectly than 
had hitherto been done, the fatal consequences of septi- 
caemia. The reviver of this plan of drainage still has san- 
guine hopes of its success, and commonly resorts to it. 

In the year 1873, Thomas M. Drysdale of Philadelphia, 
after a careful and conscientious study of the subject, de- 
scribed a peculiar characteristic corpuscle as contained in 
ovarian fluid. This he regarded as diagnostic of ovarian 
cystoma. He sums up his views upon the matter in these 
words : — 

" I claim then, that a granular cell has been discovered by me 
in ovarian fluid, which differs in its behaviour with acetic acid 
and ether from any other known granular cell found in the ab- 
dominal cavity, and which, by means of these reagents, can be 
readily recognized as the cell which has been described ; and 
further, that by the use of the microscope, assisted by these 
tests, we may distinguish the fluid removed from ovarian cysts 
from all other abdominal dropsical fluids." 

1 Haudyside, of Edinburgh, first did this in 1846. 

2 New York Med. Journ., Dec. 1872, p. 561. 



OBSTETRICS AND GYNAECOLOGY. 277 

These views are by no means generally accepted by micro- 
scopists, but their author feels sure of his position, and W. 
L. Atlee, many of whose diagnoses have in great degree 
rested upon them, has full faith in its correctness. 

In this year a remarkable paper entitled, " How do the 
Spermatozoa enter the Uterus,'" by Joseph R, Beck, of 
Indiana, appeared. The author, meeting with a female 
patient, the subject of prolapsus uteri, who was so excitable 
as to have the sexual orgasm produced by digital examina- 
tion, examined visually as this occurred, and thus reports 
what he saw : " The os and cervix uteri had been firm, hard, 
and generally in a normal condition, with the os closed so 
as not to admit the uterine probe without difficulty ; but im- 
mediately the OS opened to the extent of fully an inch, made 
five or six successive gasps, drawing the external os into 
the cervix each time powerfully, and at the same time 
becoming quite soft to the touch. All these phenomena 
occurred within the space of twelve seconds' time certainly, 
and in an instant all was as before ; the os had closed, the 
cervix hardened, and the relation of the parts had become 
as before the orgasjii." Similar observations had been 
previously made by Sitzmann,- of Germany, and published 
in 1846. 

In the next year W. L. Atlee gave to the profession a 
work entitled General and DifiTerential Diagnosis of Ova- 
rian Tumours, with special reference to the operation of 
ovariotomy, and occasional pathological and therapeutical 
considerations. This embodied his vast experience, and 
recorded the results of his numerous operations for the 
removal of tumours of the uterus and ovaries. 

In this year likewise appeared the work of D. Hayes 
Agnew, of Philadelphia, upon Laceration of the Female 

1 St. Louis Med. and Surg. Journ., New Series, vol. ix. p. 449. 

2 A. Flint, Physiology of Man, vol. v. p. 339. 

24 



ii<8 OBSTETRICS AND GYNAECOLOGY. 

Perineum and Vesico-vaginal Fistula, their liistory and 
treatment. Tliis likewise was the production of a man of 
mature thought and great experience and knowledge of the 
subject with which he dealt. To tiiis author the profession 
is indebted for a great deal of honest and valuable labour 
in reference to the surgery of the female genital organs. 

A lengthy report, in book form, of the Columbia Hospital 
for Women, in Washington, D. C, was made by J. H. 
Thompson, and a valuable essay was published by T. A. 
Emmet,^ upon Laceration of the Perineum, involving the 
Sphincter Ani, and an Operation for securing Union of 
the Muscle. Emmet in this essay urges upon operators the 
necessity of inserting the first suture low down, on a level 
at least with a horizontal line running along the lowest 
edge of the anus, so as to lift the ends of the broken muscle 
up, and cause them to approximate. This constitutes the 
pivotal point of the operation. 

In this year, also, appeared an essay by W. T. Lusk,^ on 
the Etiology and Indication for Treatment of Irregular 
Uterine Action during Labour. 

The year 1874 was very j)rolific in contributions to this 
department. In it appeared a work which has met with 
great and deserved success by Fordyce Barker, upon the 
Puerperal Diseases, and an essay by the same author,^ upon 
The Age when the Capacity for Child-bearing ceases. 

In this year two articles appeared from one of America's 
greatest ovariotomists, Gilman Kimball,* of Lowell, upon 
Pelvic Drainage after Ovariotomy ; a noteworthy report by 
the late A. K. Gardner, of a case in which ten quarts of 
urine were at one operation removed from the female blad- 

1 Med. Record, March, 1873, p. 121. 

2 N. Y. Med. Jouru., June, 1873, p. 561. 

3 Phila. Med. Times, vol. v. p. 181. 

1 Boston Med. and Surg. Jonrn., 1874, N. S., vol. xiii. p. 517, 
and vol. xiv. pp. 132, 272. 



OBSTETRICS AND GYNECOLOGY 219 

der ; a paper by H. Lenox Hocln:e,^ upon Injection of Tinc- 
ture of Iodine into the Cavity of the Uterus in Hemorrhage 
after Delivery; a report by GoodelP on The Means em- 
ployed at Preston Retreat for the Prevention and Treat- 
ment of Puerperal Diseases ; a most valuable and masterly 
essay on the Mechanism and Treatment of Breech Presen- 
tations, by R. A. F. Penrose f a description of an operation 
styled Yagino-cerviplasty,* a substitute for amputation of 
the cervix uteri in certain forms of intra-vaginal elonga- 
tion, by Pallen ; an additional paper, on The Physiological 
Lengthening of the Cervix Uteri at, before, during, and 
after Delivery, by L E. Taylor;^ one by Marion Sims,^ 
upon Enucleation of Intra-uterine Fibroids, and one upon 
Erysipelas in Child-bed Fever, by Thomas C. Minor, of 
Cincinnati. 

In the same year there appeared a work, small in propor- 
tions but powerful in style and effect, from the pen of 
Edward H. Clarke, entitled Sex in Education. Few works 
in modern times upon medical topics have so thoroughly 
succeeded in arousing the attention of the community for 
whose benefit they were undertaken. 

In 1875 James D. Trask," of Astoria, N. Y., published 
an essay upon Injection of Tincture of Iodine into the 
Cavity of the Uterus in Hemorrhage after Delivery ; J. R. 
Chadwick,^ of Boston, one upon Injection of Nutritious or 
Cathartic Fluids into the Intestines through the abdominal 

1 Am. Journ. Obstet. 

2 Amer. Sup. to Obstet. Journ. of Great Britain, 1874, July, 
p. 49, and August, p. 65. 

3 Ibid., March, 1874, p. 177. 

4 Amer. Journ. Obstet., Feb. 1875, p. 604. 

5 Ibid., May, 1874, p. 119. 

6 N. Y. Med. Journ., April, 1874, p. 337. 

7 Am. Journ. Obstet., Feb. 1875, p. 613. 

8 Ibid., Nov. 1875, p. 399. 



280 OBSTETRICS AND GYNECOLOGY. 

walls by means of an aspirator needle when the stomach 
proves entirely intolerant; A. D. Sinclair,^ of Boston, one 
upon ^Innnal Dilatation of the Os Uteri ; Xoeggerath' one 
upon Yesico-vaginal and Yesico-rectal Touch, a new 
method of examining the Uterus and Appendages ; and 
Goodell,^ a Clinical Memoir upon Turning in Pelves nar- 
rowed in the Conjugate Diameter, and another* upon The 
Management of Head-last Labours, 

In the same year Wm. H. Byford^ read before the 
American Medical Association an able report upon The 
Treatment of Uterine Fibroids by Ergot (Hildebrandt's 
method); F. D. Lente^ and Alex. Murray" published essays 
advocating the use of electricity in arresting post-partum 
hemorrhage; Parry^ one upon The Use of the Hand to 
correct unfavourable presentations and positions of the child 
during labour; and another^ upon Tlie History of an Out- 
break of Puerperal Fever at the Philadelphia Hospital, 
characterized by diphtheritic deposits on wounds of the 
genital organs; M. B. Wright'" one upon Obliquities of 
the Gravid Uterus; and Lusk,^^ a valuable report upou 
The Genesis of an Epidemic of Puerperal Fever. A very 
interesting and va]uai)le paper appeared during this year 
from H. F. CampbelV" of Georgia, upon Position, Pneu- 

^ Boston Med. and Surg. Jonrn., Feb. 1S75, p. 117. 

2 Am. Jouru. Obstet., May, 1875, p. 123. 

3 Ibid., Aug. 1875, p. 193. 
^ Phila. Med. Times, May. 

5 Trans. Am. Med. Assoc, vol. xxv. p. 173. 

^ Am. Jonrn. Obstet., Nov. 1875, p. 518. 

^ Psjcholog. and Med. -Legal .Jonrn., Jnne, 1875, p. 345. 

8 Am. Journ. Obstet., May, 1875, p. 138. 

9 Am. Journ. Med. Sci., Jan. 1875, p. 4(J. 

10 The Clinic, vol. ix. p. 301. 

» Am. Journ. Obstet,, Nov. 1875, p. 369. 

'2 Read before Georgia Medical Association, April. 



OBSTETRICS AND GYN^COLOOY. 281 

matic Pressure, and Mechanical Appliance in Uterine Dis- 
placements. Tiie author advocates replacement of uteri 
affected by posterior displacement by the assumption on 
the part of the patient of the knee-chest position, and the 
introduction of an open glass tube by herself into the 
vagina while this position is maintained. He declares that 
the position, favouring as it does gravitation of the uterus 
and other viscera forwards, aided by the entrance of air 
into the vagina by the glass tube, will commonly effect 
reposition of the displaced organ. 

During the same year a faithful Report^ upon Obstetrics 
and Gynaecology was made by Wm. T. Howard, to the 
INIedical and Chirurgical Faculty of Maryland ; an essay 
ui)on Ichthyosis of the Tongue and Vulva was published 
by R. F. Weir;^ one upon Menstruation and the Law of 
Monthly Periodicity, by J. Goodman,^ of Louisville; and 
one by D. Warren Brickell, of N. 0., upon Rupture of the 
Perineum,* with a description of a new operation. 

S. S. Todd,^ of Kansas City, published a good resume of 
the subject of Anesthetics in Labour, embodying the views 
of many prominent obstetricians in this country and in 
Europe ; and Thomas*^ a case of Tubal Pregnancy treated 
by incision into the sac by the galvano-caustic knife, and 
immediate removal of foetus and placenta through the in- 
cision thus made. 

H. L. Byrd^ published the details of a new pJan of arti- 
ficial respiration to be practised upon the neonatus. This 

' Transactions Med. and Cliir. Fac. of Med. 1875, p. 73. 

2 N. Y. Med. Journ., March, 1875, p. 240. 

3 Richmond and Louisville Med. Jouru., vol. xx. p. 553. 
* Amer. Jonrn. of Med. Sciences, April, 1875, p. 322. 

5 Trans. Med. x'Vssociation of Missouri, 1875, p. 37. 

6 N. Y. Med. Journ., .June, 1875, p. 561. 

7 Med. Record, July 31, 1875, p. 519. His first article on thi^ 
subject appeared in 1870. 

24* 



282 OBSTETRICS AND GYNiECOLOGY 

consists in tlie artificial production of the inspiratory and 
expiratory efforts by alternately bending the trunk of the 
child, held in the two palms, very much backwards and for- 
wards. As the head and shoulders fall below a horizontal 
line passing through the operator's hands placed under the 
infant's loins, and the legs and pelvis below the same line 
on the other side, air rushes into the lungs by reason of the 
recession of the diaphragm and separation of the ribs. Then 
as the diaphragm is pushed upwards, and the ribs approxi- 
mated by the anterior bending of the trunk, so that the 
child's knees approach the chin, the air is expelled. 

An essay appeared during this year also from Ellwood 
Wilson^ upon Version in contracted Pelvis. Controversial 
in style, it demonstrated the truth of the aphorism "ex 
collisione, scintilla." 

Wm. H. Byford^ in 1876 published an interesting case of 
Dropsy of the Amnion, and I. E. Taylor^ read before the 
N, Y. Academy of Medicine an essay entitled Is Craniotomy, 
Cephalotripsy, or Cranioclasm preferable to Csesarean Sec- 
tion in Pelves ranging from 1^ to 2^ inches ? 

The subject of inversion of the uterus has, during the last 
half century, attracted considerable attention in this country, 
and the valuable contributions of White, Noeggerath, Em- 
met, and others, to it, have been elsewhere noticed. The 
remarkable fact that a uterus for a long time inverted may, 
by an effort of nature, replace itself, has received due notice, 
and the evidence of American physicians has sustained that 
given of the fact by Spiegelberg, Leroux, De la Barre, 
Thatcher, Rendu, Shaw, Beaudelocque, and others of 
Europe. 

It must be borne in mind that the possibility of this 

^ Amer. Journ. Obstet., April, 1876, p. 97. 

2 Chicago Med. .Journ. and Exam., January, 1876, p. 1. 

3 Med. Record, March 15, 1876. 



OBSTETRICS AND GYNECOLOGY. 283 

occurrence has been boldly denied by liigli aiilliority, and 
that accumulation of evidence upon it is desirable. The 
case of spontaneous reposition recorded by De la Barre^ 
was presented by him before the Academy of Surgery of 
Paris, and Beaudelocque was appointed a committee to 
examine into its authenticity. He reported that the account 
was " totally false," yet some years afterwards he himself 
met with the occurrence of a similar case which convinced' 
him of his injustice to De la Barre. 

Meigs^ publishes three such cases ; Jason Huckins,^ of 
Maine, one ; and Chestnut,* in 1876, records a most striking 
case, in which, after twelve years of inversion, a uterus was 
spontaneously replaced. In the last case no doubt as to the 
diagnosis can be admitted, for during its progress careful 
examinations were made by Byford, O'Ferral, and others. 
Indeed by the former a trial at replacement was practised, 
which lasted for about two hours. 

In the May number of the Obstetrical Journal of Great 
Britain and Ireland, appears an excellent lecture upon Face 
Presentations, by Penrose; and in the January number of 
the American Journal of Medical Sciences, the report of a 
ease of ovariotomy by Gaillard Thomas, in which four days 
after operation eight and a half ounces of milk were trans- 
fused into the patient's veins with good result. Thomas's 
procedure was based upon the experience of Hodder, of 
Toronto, Canada, and Joseph W. Howe, of New York. 
The former transfused milk on three occasions, and the latter 
on two. In no case did evil consequences result, and in two 
of Hodder's cases life seemed to be saved by the process. 
Thomas's case was the sixth on record, and the results were 
excellent. Since his publication J. W. Howe has experi- 

» Archiv. Gen. de Med., 1S6S, t. ii. p. 393. 

2 Obstetrics. 3 Thomas' Dis. of Women, 4th ed. p. 431. 

4 Amer. Practitioner, May, 1876, p. 284. 



284 OBSTETRICS AND GYNECOLOGY. 

mented on the subject witli very unfavourable results. Trans- 
fusion of milk practised upon seven dogs, has in every case 
resulted in death, and in one man suffering from pulmonary 
consumption in the third stage death from coma occurred a 
few hours after the operation. The subject demands, and is 
certainly worthyof, full and careful investigation. It is dif- 
ficult to reconcile the discrepancy of results which now at- 
taches to it. At present the sul)ject stands thus : up to 1875 
six transfusions upon the living subject with no evil result, 
and with three instances of great benefit : during 1876 one 
transfusion upon man, and seven upon dogs, with fatal con- 
sequences in every case. 

In the yearly contributions to medical literature there is 
a great deal of faithful, arduous, and useful work done, which 
redounds but little to the immediate advantage of the doers. 
This is the work done by reviewers. To J. C. Reeve, of 
Dayton, Ohio, this department of medicine is much indebted 
in this respect. His reviews of the subject of anaesthesia 
which have appeared in the American Journal of the Medi- 
cal Sciences, are well known. 

The mental development which appears thus far to have 
resulted from the peculiar education and training which 
characterize the civilization of this country, exhibits a much 
more marked tendency to the adaptation of means to im- 
mediate practical results, than to a devotion to abstruse 
study or pains-taking scientific investigation. Hence a 
fruitful harvest would naturally be expected in the way of 
ingenious appliances and well-conceived instruments, the 
outcome of a century of experimentation. This expectation 
will not be disappointed either in this or any other of the 
practical departments of medicine. 

A vast number of modifications of the obstetric forceps, 
both short and long, have been made; so large a number, 
indeed, that even a mention of them would prove impossible. 
The most valuable and generally popular of these is the 



OBSTETRICS AND GYNECOLOGY, 285 

long forceps of Hodge. Two other excellent modifications 
are those of the late George T. Elliot and of J. P. White. 
The two latter are light, yet powerful ; elegant in shape ; 
and well adapted to the varied requirements of this most 
useful of surgical instruments. 

Of vaginal specula there is rapidly being created as great 
a variety as that of forceps. Sims' great invention, de- 
veloping an entirely new method of examination, certainly 
takes the lead of all others, and up to the present date 
none other can be compared with it for practical advan- 
tages. This instrument, however, requires two things for 
its employment — first, a certain degree of skill on the part 
of the operator in its use ; and, second, an assistant to hold 
it during examination. To avoid the necessity of the 
second requirement, modifications have been made by 
Howard, Emmet, Hunter, Bozeman, Byrne, Nott, Otto, 
Noeggerath, and many others. 

It would be useless to enumerate, as an original concep- 
tion, each instrument employed in the operation for cure of 
vesico-vaginal fistula, for all of these were invented by 
Sims, as the pioneer in this procedure. 

The uterine repositor of Sims is the best instrument yet 
devised for replacing the retroflexed or retroverted uterus. 
It is far superior to the ordinary uterine sound in efficiency, 
and unattended by its dangers. The same remarks apply to 
Sims' silver uterine probe, as compared with the unyielding 
sounds of Simpson, Huguier, and Kiwisch. 

In operations upon the vagina and perineum, Emmet's 
curved scissors are very useful, and greatly facilitate these 
procedures ; and after operations for atresia, Sims' vaginal 
plug of hard rubber or glass is indispensable. 

For dilating a constricted nterine neck, Molesworth has 
furnished us an excellent instrument in his hydrostatic dila- 
tors, which, though acting upon the same principle as the 



286 OBSTETRICS AND GYNAECOLOGY. 

water-bags of Dr. Barnes, are more powerful and manage- 
able. 

The syringe of Davidson is a valuable one for accom- 
plishing vaginal irrigation, and the induction of premature 
delivery. 

In many operations for the removal of abdominal tumours, 
temporary control of hemorrhage can be perfectly accom- 
plished by H. R. Storer's clamp-shield, which becomes, 
under these circumstances, a valuable instrument. Perma- 
nent clamps have been devised by Atlee, Dawson, Tiiomas, 
and Greene, of PortLind. The last of these consists of a 
spring clamp, intended to cause ligatures placed around 
the pedicle to cut through, and thus be liberated. 

The galvano-caustic battery, only of late years introduced 
amongst us as a means of amputating vascular parts like 
the cervix uteri, etc., has now become very popular, and the 
ingenuity of Byrne and Dawson has furnished us with in- 
struments at once small, portable, and very powerful. These 
instruments weigh only five or six pounds, and occupy little 
more space than an octavo volume. Their present dimen- 
sions and certainty of action remove two of the greatest 
objections attaching to the cumbrous and fickle instruments 
formerly in use. 

For a long time after pessaries were put upon their 
proper basis as surgical appliances of great value, and as 
means which were essential to the proper management of 
uterine displacements, few modifications were made in them. 

Of late years, however, this has not been so. Hodge's 
instrument has been usefully modified by Albert H. Smith .^ 
Many varieties of vaginal stem pessaries have been devised 
for prolapsus ; and Ei)hraim Cutter, of Boston, has accom- 
})lished a valuable improvement in retroversion pessaries 

' Obstet. Journ. of Great Britaiu, Amer. Sup., 1875, vol. ill., 
p. 7. 



OBSTETRICS AND GYNECOLOGY. 287 

by getting support by a stem arching backwards over the 
perineum, and attaching to a belt worn around the waist. 

In certain operations upon the anterior vaginal wall, the 
apparatus of Bozeman, by which the patient can be kept 
in a modified genu-pectoral attitude, proves very useful ; by 
its use anaesthesia may be kept up for a long time with per- 
fect comfort to the patient. 

John T. Hodgen, of St. Louis, has made the needles 
employed in operations for vesico-vaginal fistula trocar- 
pointed, with great advantage. Their power of penetration 
is great, while at the same time they do little damage by 
cutting the tissues. 

Parvin's polyptome is a very useful instrument for the 
removal of growths attached in utero, which are out of 
reach of manipulations practised by the instruments ordina- 
rily in use. 

A most valuable improvement in the trocar and canula 
for tapping the abdomen and abdominal tumours has been 
effected by S. Fitch, in his "dome trocar." By this instru- 
ment complete protection is given to the viscera by a pro- 
jecting piece which shields them from its sharp point. 

An excellent double canulated tube has been intro- 
duced for pelvic drainage by George H. Bixby, of Boston. 
It fulfils every requirement under these circumstances as to 
thoroughness and facility of employment. 



LITERATURE AND INSTITUTIONS. 



BY 
JOHN S. BILLINGS, M.D, 

ASSISTANT SUKGEOX CXITED STATES AR31V. 



25 



LITERATURE AND INSTITUTIONS. 



" "Wherefore, by their fruits ye shall know them." 

Besides liis duties to his patients, the physicinn is under 
certain oblig-ations to contribute, by way of interest, his 
quota to the common stock of medical knowledge from 
which he has drawn so freely. The skilful diagnosis, judi- 
cious medication, or bold and successful operation, if not 
properly recorded, benefit the individual only, not being 
available for those comparisons and higher generalizations 
which alone can make medicine a science. By the manner 
in which this duty, of preserving and transmitting the 
results of its labour and experience, has been performed, 
the medical profession of a country, as well as the individual 
physician, must to a great degree be judged, and the question 
now presented is, to what extent and in what manner have 
the physicians in the United States fulfilled this part of 
their professional obligations during the century just 
passed. 

In the retrospective reviews, historical sketches, and cen- 
tennial addresses which have, during the past year, been 
devoted to American medicine, our most important contri- 
butions to the healing art have been duly pointed out, and 
for the most part sufficiently eulogized. That the United 
States has a medical literature, has been cumulatively 
demonstrated, even to the extent of raising a suspicion of 
the existence of a doubt upon this point; and that this 
literature contains manj valuable original contributions to 



292 LITERATURE AND INSTITUTIONS. 

the art, if not to the science, of medicine may be considered 
as unanimously aflfirmed and admitted. 

If the defects of which all are more or less aware, have 
been but slightly referred to, it is because the purpose of 
the writers has been rather eulogistic than critical. In this 
final article of the present series, the object is not to select 
for praise the best of the w^ork, nor the reverse, but to 
endeavour to give an idea of the quantity and value of the 
whole of it. So far as individual writers are concerned, an 
attempt will be made to supplement the information given 
in previous papers, but these have been so complete as 
regards that which is worthy of notice, that little need be 
said of single books and articles. 

We will first endeavour to give some account of the 
quantity of medical literature produced in the United States 
during the last hundred years ; making use for the purpose 
of some statistics obtained from a nearly complete list of 
the medical books published in this country from 1770 to 
the present time, and from which it may be considered cer- 
tain that no important work has been omitted. 

In these statistics w^e do not include works intended for 
the non-medical public, those relating to "ics" or "pathies,'* 
nor the great mass of what are called pamphlets in the 
technical sense of the word, that is, books of less thnn one 
hundred pages. The great mnjority of these pamphlets are 
either reprints from periodicals, addresses inaugural or vale- 
dictory, a few of which contain historical data of interest, or 
controversial and personal disquisitions which are best for- 
gotten. While it is true that there is no necessary connec- 
tion between the size of a work and its practical or scientific 
value, it will be found that with a very few exceptions, 
which have been pointed out in the preceding articles of 
this series, nothing of interest or importance is omitted by 
this division. The books to be counted may be classified 
as follows : — 



LITERATURE AND INSTITUTIONS. 293 

I. Systematic treatises and monographs by physicians 
residing in this country, including reports of hospi- 
tals, corporations, and government departments. 
II. Reprints and translations of foreign medical books. 
III. Medical journals. 
lY. Transactions of medical societies. 

The first, third and fourth classes include what is ordi- 
narily meant by the phrase "American Medical Literature." 
From them are excluded books written by American authors, 
but printed abroad, as, for instance, those of Dr. Wm. 
Charles Wells; while on the other hand, they include books 
written by physicians born and educated abroad, but who 
may be said to have become citizens of this country, such as 
Tytler, Pascalis, Bushe, Dunglison, Jacobi, and Knapp. 

The statistics of the four classes above given, include not 
only the medical literature of the United States for the cen- 
tury, but nearly all which the country has produced since 
the first settlement. At the commencement of the Revolu- 
tionary War, we had one medical book by an American 
author, three reprints, and about twenty pamphlets. The 
book referred to is the " Plain, Precise, Practical Remarks 
on the Treatment of Wounds and Fractures," by Dr. John 
Jones, New York, 1775. It is sim})ly a compilation from 
Ranby, Pott, and others, and contains but one original ob- 
servation, viz. , a case of trephining followed by hernia cerebri. 

The libraries of our physicians were composed, according 
to Bartlett,^ of the works of Boerhaave, with the Commen- 
taries of Yan Swieten, the Physiology of Haller, the 
Anatomy of Cowper, Keil, Douglass, Cheselden, Monroe, 
and Winslow; the Surgery of Heister, Sharp, Le Dran, 
and Pott; the Midwifery of Smellie ; the Materia Medica 
of Lewis ; and the works of Sydenham, Whytt, Mead, 

' A Dissertation on the Progress of Medical Science in tlie Com- 
monwealth of Massachusetts, Boston, 8vo., 1810. 

25* 



294 



LITERATURE AND INSTITUTIONS, 



Brookes, and Huxliam. The works of Ciilleii were just be- 
ginning to be known. The only public medical library was 
that of the Pennsylvania Hospital, which contained, perhaps, 
two hundred and fifty volumes. There were probably not 
two hundred graduates of medicine in the country, and not 
over three hundred and fifty practitioners of medicine who 
hud received a liberal education. Two medical schools had 
just begun, but had accomplished little previous to the war 
which closed them, there were no medical journals, and but 
one State Medical Society, that of New Jersey, had been 
organized. From this unpromising condition of things, 
have been developed the literary results, of which we now 
present a summary. 

Table showivg immher of Medical Books 'printed in the United 
States from January 1, 1776, to January 1, 1876. 



• 


1 
1775 1800 


I'll 
1810 1820 1830 1840 1850 


1860 1870 






to 


to 


to 


to 


to 


to 


to 


to 


to 


ci 




1799 1809 


1819 


1829 1839 


1849 


1859 


1869 


1875 


H 


Class I. 






















Americnn ( No. 1st edition 


39 


24 


51 


48 


83 


96 


101 


157 


130 


729i 


Medical < No later editions 


y 


4 


14 


17 


34 


49 


80 


85 


44 


336' 


Books (No. Vols. Total 


51 


31 


77 


86 


136 


162 


197 


266 


180 


1176 


Class II. 






















Reprints T No. 1st edition 


28 


39 


64 


72 


145 


1.35 


99 


104 


81 


767 


and «; No. later editions 


11 


23 


28 


33 


36 


67 


76 


64 


50 


388 


Trans. ( No. Vols. Total 


49 


76 


111 


135 


192 


214 


184 


160 


137 


1274 


Class III. 






















Medical ^ No. Journs.com'eed 
Journals ( " " discont'd 


1 


5 


6 


17 


18 


26 


52 


38 


32 


195 




3 


5 


10 


18 


14 


31 


36 


20 


137 


"A." 
p. . . , CNo. Vols, com'nced 
Original |no. Vols, coinpl'ted 


2 


21 


27 


85 


104 


173 


376 


292 


296 


1376 


2 


20 


27 


79 


98 


166 


366 


271 


283 


1312 


"B." 
•r, • i. ^ No. Journals 
Reprints J j^^ Volumes 

Class IV. 






1 
9 


4 
29 


"20 


5 
46 


1 
71 


3 
51 


3 
32 


17 

258 


























Transactions ^ -^^ t7-„i.„^„„ 
Med. Societies? ^^•^^^"^'^ 


7 


3 


2 


6 


17 


27 


76 


88 


111 


336 



LITERATURE AND INSTITUTIONS. 295 

It will be seen from this table, that the medical literature 
of the United States really commences with the present 
century, and this is still more apparent, if the character of 
the works issued prior to 1800, be considered. 

The first literary contributions of our physicians, after the 
close of the war, are contained in the memoirs of the 
American Academy of Arts and Sciences, Boston, 1785, and 
in the Transactions of the American Philosophical Society 
at Philadelphia, 1786. The first original separate work w-as 
the " Cases and Observations by the Medical Society of New 
Haven County, in the State of Connecticut," New Haven, 
86 pp., 8vo., 1788. This is a collection of twenty-six 
articles, including several cases and autopsies, of interest, 
and a paper on the production of dysentery among troops- 
by overcrowding and foul air, in which the connection of 
cause and effect is clearly demonstrated. 

The majority of the succeeding publications, to the end of 
the century, related to the yellow fever, which was then 
epidemic along the whole Atlantic coast. The most promi- 
nent author of this period is Benjamin Rush, noteworthy 
also as an orator and politician. His writings excel in 
manner rather than matter, and the undoubted influence 
which he exerted over the earliest stages of American medi- 
cine, was probably due to his lectures rather than his pub- 
lished works. The best of his essays, and indeed the only 
one to-day worth consulting, is that on diseases of the mind, 
which contains some original observations of interest. One 
of his eulogists. Dr. Ramsay,^ says: " On the correctness of 
this opinion [viz., his fondness for the use of the lancet] his 
fame as an improver of medicine in a great degree must 
eventually rest." And to the correctness of this judgment 
we entirely assent. 

J Eulogiuni upon Benjamin Rush, by David Ramsaj, Philadel- 
phia, 1813, 8vo., pp. 79. 



296 LITERATURE AND INSTITUTIONS. 

The work of James Tytler^ is a good compilation, and 
contains, among other data not to be found elsewhere, an 
interesting letter bj Dr. John Warren, of Boston. Tjtler 
was born in Scotland in 1747, came to this country about 
1796, and was drowned in 1804; he possessed extensive 
and varied learning, and wrote much, but for the most part 
on non-medical subjects. 

The works of Noah Webster,'^ though mainly historical, 
are still of interest, and worth preservation. 

Another writer of this period is Dr. William Curry, a 
native of Pennsylvania, 1755-1829. At first educated for 
the church, he acquired an excellent knowledge of Latin 
and Greek, and studied medicine under Dr. Kearsley, of 
Philadelphia. During the Revolutionary War he served as 
surgeon in the American army, being attached to the mili- 
tary hospital on Long Island, in 1776. After the war, he 
at first settled at Chester, but removed to Philadelphia about 
1791. He was one of the original fellows of the College of 
Physicians of Philadelphia, and for many years a member of 
the Board of Health. His principal works in addition to 
his numerous pamphlets and articles on yellow fever, are his 
" Historical Account of the Climates and Diseases of the 
United States," 1792; and his "View of the Diseases most 
Prevalent in the United States," Philadelphia, 1811. 

Towards the close of the century, and for a few years 
thereafter, there w^ere published in Boston, New York, and 
Philadelphia, a number of medical theses, which, being 

J A Treatise ou the Plague and Yellow Fever, with an Appendix, 
8vo., 1799. 

2 A Collection of Papers on the subject of Bilious Fevers, preva- 
lent in the United States for a few years past. 24G pp. 8vo. New 
York, 1796. A Brief History of Epidemic and Pestilential Diseases ; 
with the principal Plienomona of the Physical World which precede 
and accompany them, and Observations deduced from the facts 
stated. 2 vols., 8vo., Hartford, 1799. 



LITERATURE AND INSTITUTIONS. 297 

classed as pamphlets, are not taken into account in our 
statistics, and are noticed here for the sake of saying a word 
with regard to this class of medical literature. A medical 
dissertation prepared, not for the press, but simply as a for- 
mality necessary for the obtaining of a diploma, as is the case 
with nearly all those which have been presented at our medi- 
cal schools for the last fifty years, fairly merits the denuncia- 
tion of Professor Gross, "that not one in fifty affords the 
slightest evidence of competency, proficiency, or ability, in 
the candidate for graduation." 

Such was not the case, however, with regard to the theses 
above referred to, nor can it be justly said with regard to 
any series of printed theses of the European schools. It 
would seem, therefore, that when prepared as they should 
be, with reference to the probable criticisms, not merely of 
a single professor, bnt of the press and the public, there is 
the strongest inducement to refrain from plagiarism, and to 
produce the best work of w^hich the candidate is capable; 
and it is well known to those who have had frequent occa- 
sion to consult them, that collections of printed medical 
theses are valuable, as historical documents, presenting a 
reflex of the teachings of the school, and as containing 
accounts of cases and original investigations, or particular 
doctrines of the student's preceptor, which cannot be found 
elsewhere. Tiie proportion of copied matter, vague specu- 
lations, and other rubbish, does not, upon the whole, appear 
to be so much greater in this than in some other classes of 
medical literature, as to warrant their wholesale condemna- 
tion ; and the remedy for the present unsatisfactory character 
of the theses of our medical students, appears not to be 
their abolition, but the requiring that they shall be printed, 
and considered as an important and real test of the merit of 
the candidate. They should of course be written in the 
vernacular. The influence which a teacher has in directing 
the thougiits of his pupils, is very well shown in ihe theses 



298 LITERATURE AND INSTITUTIONS. 

of the Pliiladelphia school, a considerable number of which 
related to medical botany, under the stimulus given by Dr. 
Barton to that branch of study. 

During this period, and prior to the establishment of any 
medical journal, or regular publication of the transactions 
of any medical society, a number of communications from 
American physicians were sent to societies in Europe, and 
appear in their transactions. Perhaps the most notable 
paper of this kind was "An Experimental Inquiry into the 
Properties of Opium," by John Leigh of Virginia, which 
obtained the Harveian prize for 1*785, and was printed at 
Edinburgh in the following year. It is worth consultation, 
not only for the facts which it records, but for the method 
of investigation pursued, which was unusual in that day of 



e 



From the year 1800 to the present time, the above tabl 
shows that there has been a steady increase in the amount 
of our indigenous medical literature, corresponding in the 
main to our increase in population and wealth. To obtain 
some notion of the quality and value of this production, a 
more detailed analysis is necessary. 

The greater part of these books are compends relating to 
the treatment of diseases and injuries. Those which have 
been most popular, and are the best known, are the text- 
books and systematic treatises. These are for the most part 
compilations, but their importance is by no means to be 
underestimated, for the practice of the majority of the phy- 
sicians of this country to-day, is based on the text-books of 

' In this connection also may be mentioned a rare and little 
known work, being the oration delivered at the University of 
Virginia in 1782, by ,L F. Coste, the Medical Director of the Fl-ench. 
Forces. Its subject is " Antiqna novum orbem decet medico philo- 
sophia ;'' it is dedicated to Washington, of whom the author was a 
personal friend, and makes a volume of 103 {ages, 8vo. ; printed at 
Leyden, in 1783. 



LITERATURE AND INSTITUTIONS. 209 

the teachers in the "N'ew York and Philadelphia schools. 
Also we must remember tliat "there are compilations and 
compilations." The preparation of such systematic treatises 
as those of Flint, Gross, Stille, and Wood, does not require 
less labour or thought, or give less scope for display of 
genius, than the so-called original monographs. 

Writers of this chiss bring into their proper relations the 
isolated facts and observations scattered through many 
books, give them the mint stamp of value, and put them into 
general circulation. 

For reasons already stated, and for want of space, but few 
books can here be noticed, even by title, and in connection 
with these will be given some very brief biographical data 
relating to a few authors. Of living writers and their 
works, as little as possible will be said. 

In Anatomy our principal systematic works have been 
produced by Wistar, Horner, Morton, Richardson, Agnew, 
Hodges, Leidy, and Smith. Kone of them are now of 
interest. Dr. Caspar Wistar, 1761-1818, was of German 
descent, and a native of Philadelphia. Having obtained a 
good classical education, he studied medicine under Dr. 
John Redman, and took the degree of Bachelor of Medi- 
cine, in 1782. He continued his studies at Edinburgh, 
where he graduated M.D. in 1786. Returning to Phila- 
delphia, he became Adjunct Professor of Anatomy in 1791, 
and continued to lecture until his death. His System of 
Anatomy was issued in parts, 1811-1814, making two 
volumes, and was a popular text-book for a longtime. 

The first work issued by Dr. Horner was a Dissector's 
Manual, in 1823. This was followed by his treatise on 
General and Special Anatomy in 1826, his Anatomical Atlas, 
and treatise on General and Special Histology. 

A good original work has yet to be written on this last 
subject, in this country. In surgical anatomy, Drs. Anderson 
and Darrach have produced partial treatises, the first on the 



300 LITERATURE AND INSTITUTIONS. 

groin, pelvis, and perineum, New York, 1822; the second 
on the anatomy of the groin, Philadelphia, 1830. 

Drs. N. R. Smith, Goddard, and Neill, have each issued 
a worli on the Surgical Anatomy of the Arteries. Among 
the few original works in this department, should be men- 
tioned those of Dr. John D. Godman, a native of Annapolis, 
Md., 1794-1830. Poor and almost friendless, but urged 
on by an unquenchable thirst for knowledge, he persisted in 
obtaining an education in spite of the greatest difficulties 
and discouragements, and at last took the degree of M.D. 
at the University of Maryland in 1818. 

In 1821 he went to Cincinnati to accept a chair in the 
Medical College of Ohio, but dissensions in the faculty 
induced his s{)eedy resignation. He then established a 
medical journal hereafter to be alluded to, but in 1822 went 
to Philadelphia and began a course of private lectures in 
anatomy. In 1826 he accepted the chair of Anatomy in 
Rutgers College in New York, but failing health soon com- 
pelled him to cease teaching, although he continued to use 
his pen until just before his death. Pr. Godman was an 
anatomist by nature, and though the necessities of bread- 
winning prevented him from accomplishing any great work, 
his treatise on the fascia^ and his contributions to physio- 
logical and pathological anatomy^ are really original and 
valuable productions. 

The papers of Dr. John Dean on the "Microscopic 
Anatomy of the Lumbar Enlargement of the Spinal Cord," 
Cambridge, 1861, and on "The Gray Substance of the 
Medulla Oblongata," published by the Smithsonian Institu- 
tion in 1864, are the results of careful work, and are note- 

' Anatomical Investigations, comprising Descriptions of Various 
Fasciae of the Human Body, 8vo., Philadelphia, 1824. 

2 Contributions to Physiological and Pathological Anatomy, 8vo., 
Philadelpliia, 1825. 



LITERATURE AND INSTITUTIONS. 301 

worthy for the use made of photo-lithography from micro- 
photographs to obtain the illustrations. 

The craniological works of Drs. Morton and J. A. Meigs 
should be referred to here. Dr, Samuel George Morton, 
1799-1851, was a native of Philadelphia, and graduated in 
medicine at the University of Pennsylvania in 1820, after 
which he continued his studies for three years at Edinburgh, 
obtaining his degree in 1823. From 1839 to 1843 he was 
Professor of Anatomy in the Pennsylvania Medical College. 
His fame rests upon his "Crania Americana," Philadelphia, 
1S39, and his "Crania Egyptiaca," ibid., 1844; works which 
have a world-wide reputation, and whose value is permanent. 
His labours in this direction have been continued by Dr. J. 
Aitken Meigs, whose "Catalogue of Crania," Philadelphia, 
1857, is well known to all who are interested in this subject. 

In physiology, our text-books have been the works of 
Dunglison, Draper, Dalton, and Flint, all too well known to 
require more than a mere reference. The work of Professor 
Draper, published in 1853, was the first in this country in 
which raicro-photographs were used to obtain illustrations. 
To these may be added the works of Reese, Oliver, Goadby, 
and Paine. Of special treatises and essays, the most im- 
portant are Beaumont's Experiments on Digestion, Platts- 
burgh, 1833; Draper '' On the Forces which produce the 
Organization of Plants," New York, 1844; Joseph Jones' 
"Investigations," published by the Sniithsouian in 1856; S. 
W. Mitchell's "Researches upon the Venom of the Rattle- 
snake," idem, 1860 ; and Hammond's "Physiological Me- 
moirs," Philadelphia, 1863. In this department Brown- 
Sequard may be claimed as an American author; some of 
his researches having been made, and the results first pub- 
lished in this country. Those who are familiar with the 
literature of thirty years ago will remember with a smile, 
the treatise of Emma Willard on the circulation of the blood, 
and the controversies to which it gave rise. The "Essays 



302 LITERATURE AND INSTITUTIONS 

on the Secretory and the Excito-Secretory System of 
Nerves," by Dr. H. F. Campbell of Georgia, Philadelphia, 
1857, should be remembered in this connection, as also the 
pamphlets of Dr. Dowler of New Orleans. 

In the department of JNIateria Medica and Therapeutics, 
we have made a good record. In Medical Botany, the works 
of B. S. Barton and Jacob Bigelow deserve especial mention 
as works of permanent value. The " Illustrations of Medical 
Botany," edited by Dr. Carson, Philadelphia, 1847, contain- 
ing one hundred plates, in folio, is a rare and costly work, 
a considerable part of the edition having been destroyed by 
fire. 

The first systematic treatise on Materia Medica and The- 
rapeutics, produced in this country, was that of Dr. Chap- 
man, Philadelphia, 1817. This was followed by the works 
of Eberle, J. B. Beck, Dunglison, Harrison, G. B. Wood, 
T. D. Mitchell, Biddle, Stille, Riley, and H. C. Wood, all of 
which have been, or are popular text-books in the schools. 

The majority of these authors will be referred to under 
other sections, but of three, a few words may here be said. 
Dr. John P. Harrison was born in Louisville in 1796; 
studied under Dr. Chapman, and graduated in medicine in 
1819. He was Professor of Materia Medica in the Cincin- 
nati College from 1836 to 1839. In 1841 he accepted the 
same chair in the Medical College of Ohio, in 1847 was 
transferred to that of Theory and Practice, and died of 
cholera in 1849. He was one of the editors of the Western 
Journal of Medicine, and of the Western Lancet; published 
a collection of his essays in 1835, and his "Elements of 
Materia Medica and Therapeutics" in 1846. 

The principal work on Materia Medica is the "United 
States Dispensatory" of Wood and Bache. Dr. Franklin 
Bache was born in Philadelphia in 1792, and died in 1864. 
Graduating as Bachelor of Arts in 1810, he studied under 
Dr. Rush, and obtained his medical degree in 1814. His 



LITERATURE ANU INSTITUTIONS. o03 

tastes led him to the special study of chemistry, of which 
branch he was appointed professor in the Franklin Institute, 
in 1826. In 1841 he accepted the same chair in the Jefferson 
School. His principal work was in connection with the 
United States Pharmacopoeia and the Dispensatory, which 
have made his name familiar to every physician in the United 
States. The first proposal to form a Pharmacopoeia in this 
country was made to the College of Physicians of Philadel- 
phia, in 1787, with the result of the appointment of a com- 
mittee, which seems to have continued about ten years, but 
effected nothing. In 1808 a Pharmacopoeia was published 
by the Massachusetts Medical Society, and in 1816 ai^other 
was issued by the New York Hosj)ital. Our present national 
Pharmacopoeia originated in a plan submitted to the New 
York County Medical Society, in 1817, by Dr. Lyman 
Spalding. A leading part in the formation of the first edi- 
tion, by the convention which met in Washington in 1820 
for that purpose, was taken by the College of Physicians of 
Philadelphia, through its delegates, and more especially by 
Dr. Thomas T. Ilewson ; and in the subsequent revisions, 
Drs. Hewson, Bache, and Wood were the principal workers. 
The first revision, adopted in 1830, was entirely the produc- 
tion of these gentlemen, and was substantially a new work. 
The Dispensatory was projected by Drs. Wood and Bache 
as an exposition of the Pharmacopoeia, and a means of 
making it more popular. 

The exposition has, so far as our physicians are concerned, 
entirely overshadowed the text, and in a financial point of 
view, the Dispensatory is the most successful medical book 
ever published in this country. 

Among writers on Materia Medica, distinguished in their 
day, may be mentioned Dr. William Tully, 1785-1859, who 
graduated at Yale in 1806, and attended medical lectures 
at Dartmouth College in 1808-9. He received the honorary 
degree of M.D. from Yale in 1819. In 1824, he was 



304 LITERATURE AND INSTITUTIONS. 

appointed Professor of Theory and Practice in the Castleton 
School, and in 1826 removed to Albany, forming a partner- 
ship with Dr. Alden March. In 1829, he accepted the chair 
of Materia Medica and Therapeutics at Yale, and removed 
to New Haven, but continued his lectures in Castleton until 
1838. He ceased teaching in 1841. His principal works 
were the "Essays on Fevers," published with those of Dr. 
Miner 1823, a work which gave rise to much controversy, 
and was, upon the whole, not favournbly received; a prize 
essay upon Sanguinaria, published in the American Medical 
Recorder in 1828; some papers in the Boston Medical 
Journal ; and finally, his treatise entitled " Materia Medica, 
or Pharmacology and Therapeutics," Springfield, 185*7-58, 
in two large volumes 8vo. This was published in numbers, 
was not a popular work, nor calculated for the use of a 
student, but shows great industry and learning in every 
page. Complete copies of it are not now easily obtained, 
although it cannot be said to be rare. His sty]e is discur- 
sive, diffuse, and polysyllabic, and a decided effort is neces- 
sary to peruse his writings; but his knowledge of facts was 
minute and exact, and his last work is a mine of informa- 
tion, which is even now worth exploring by tlie curious. 

In Surgery, our indigenous text-books have been pro- 
duced by Dorsey, Gibson, S. D. Gross, Aslihurst, and Ham- 
ilton. On Oi)erative Surgery we have the treatises of Pan- 
coast, Piper, H. H. Stnith, Stephen Smith, and Packard. 
The posthumous work of McClellan is not a systematic 
treatise, but a series of essays and cases, in which the 
description of Shock is especially noteworthy as being true 
to life. Of monogra|)hs, the most valuable are those by 
Professor Gross, on Wounds of the Intestines, 1838: on 
Diseases of the Bladder, 1851-55 ; on Foreign Bodies in the 
Air-passages, 1854 and 1862; and Diseases of the Bones 
and Joints, 1830; F. H. Hamilton on Fractures and Dislo- 
cations, 1860, fifth edition, 1875 ; Durkee and Bumstead on 



LITERATURE AND INSTITUTIONS. 305 

Venereal ; Van Buren and Keyes, and Gonley on the Urinary 
Organs ; Bnshe on Diseases of the Rectum ; Carnochan on 
Congenital Dislocations of the Head of the Femur; H. J. 
Bigelow on the Mechanism of Dislocation and Fracture of 
the Hip ; Ashhnrst on Injuries of the Spine ; Markoe on 
Diseases of the Bones; and Garretson's Oral Surgery. 
S[)ecially valuable collections of cases, are the works of 
John C. Warren, on Tumors, Boston, 1837 ; and of J. 
Mason Warren; the pamphlets of Sayre on Orthopaedic 
Surgery; N. R. Smith on Fractures of the Lower Extremity ; 
and J.C. Xott, "Contributions to Bone and Nerve Surgery." 
As an example of careful statistical work, the treatise of R. 
M Hodges on "The Excision of Joints," Boston, 1861, is 
to be specially commended. 

The treatise of Dr. Gross, on Wounds of the Intestines, 
above referred to, first appeared in the "Western Journal of 
Medicine;" it contains the results of numerous experiments 
and observations, and is of much practical value and interest. 
It is a rare book, and a copy of it may properly be considered 
a prize by the collector. 

In Military Medicine and Surgery nothing of value was 
produced by the revolutionary war, the war of 1812, or the 
war with Mexico. This deficiency has been, to a great 
extent, made up by the number and value of works resulting 
from our late war. 

The Medical and Surgical History of the War will be, 
when completed, the largest medical work ever produced in 
this country. The publications of the Sanitary Commission, 
including the works of Flint, Gould, and Lidell, contain 
valuable data. The manuals of military surgery have been 
written by Gross, Hamilton, Tripler, Blackman, Chisholm, 
and Warren. Other works which should be remembered in 
this connection are. Woodward on Camp Diseases, the 
statistical reports and circulars issued from the Surgeon 
General's Office, and the medical statistics of the Provost- 

26* 



306 LITERATURE AND INSTITUTIONS 

Marshal General's Office, compiled by Dr. Baxter, making 
two handsome qnarto volumes, which are a most valuable 
addition to our knowledge of anthropometry and medical 
topography. 

In the departments of Theory and Practice of Medicine, 
we have produced a fair amount of monographs and text- 
books, the most important of the latter class being those of. 
Chapman, Eberle, G. B. Wood, and Flint. The following 
is a brief outline of the lives of a few who were our principal 
writers and teachers in this branch of medicine, but who 
now rest from their labours. Among them, there are few, 
who, in their day, had a more extended reputation, or were 
more popular than Dr. Nathaniel Chapman. 

Born in Virginia in HSO, he received an excellent general 
education, became a pupil of Dr. Rush, with whom he was 
a favourite, graduated at the University in 1800, then spent 
three years in Euro})e, one as a pupil of Abernethy, and 
two at Edinburgh, and in 1813 was elected to the chair of 
Materia Medica in his Alma Mater, to be exchanged in 
1816 for that of the Theory and Practice of Medicine, which 
he held until 1850, when he resigned. He died in 1853. 
His "Therapeutics and Materia Medica," published in 
1817, was the best work of the kind in English at that date. 
He was ,the first President of the American Medical Asso- 
ciation after its permanent organization ; President of the 
American Philosophical Society, a popular lecturer, a genial 
companion, and in his prime probably the most distinguished 
physician in the United States. He edited, for seven years, 
the Philadelphia Journal of the Medical and Physical 
Sciences. Many of his lectures were published in the 
"Medical Examiner," in 1838-40. Two volumes of these 
lectures were published in 1844, and a compendium of his 
course on theory and practice was issued in 1846. 

Contemporary with Dr. Chapman, and for twenty-five 
years associated with him as a teacher, was Dr. Samuel 



LITERATURE AND INSTITUTIONS. 307 

Jackson, 1TS7-18T2, a native of Philadelphia, and educated 
in the University of Pennsylvania, having grsiduated in 
medicine in 1808. From 1825 to 1863, he was Professor 
of the Institutes of Medicine in his Alma Mater. His 
"Principles of Medicine" (Philadelphia, 1832, 8vo.) was a 
treatise on pathology, founded on the doctrines of Broussais, 
and received high praise in its day. It was also the subject 
of a long and acrimonious critical review by Dr. Caldwell. 
The popular story that Dr Jackson recalled all the copies 
of this work that he could is incorrect; the entire edition 
was sold in the usual manner, and tlie publishers desired to 
issue another, but the author refused, on the ground that 
the science was nndergoing such rapid and great changes 
thnt he would feel it necessary to re-write the entire work, 
a labour which his health and the demands of his private 
practice would not allow him to undertake. His most im- 
portant writings are contained in the American Journal of 
the Medical Sciences, the last being a paper on a rare dis- 
ease of the joints, in the July Number for 1870. 

Dr. John Eberle, 1788-1838, was of German descent, and 
a native of Pennsylvania. After graduating in medicine in 
1809, he went into politics, edited a newspaper, acquired 
intemperate habits, and became a bankrupt. Commencing 
life again, in 1825 he took the chair of Theory and Practice 
in the Jefferson School, which he held until 1831, when he 
removed to Cincinnati, and became connected with the 
Faculty of the Medical College of Ohio, In 1837, he 
removed to Lexington, Ky., to accept a chair in the Tran- 
sylvania School, but could not lecture, and soon died. His 
treatise on the Practice of Medicine, first published in 
1829, was, in its day, a very popular work, in part at least 
because of the formulae which it contained, but is now for- 
gotten. 

Dr. Elisha Bartlett, born in Rhode Island in 1804, died 
1855, graduated in medicine at Brown University in 1S2G, 



308 LITERATURE AND INSTITUTIONS. 

after which he spent a year in Paris. He held Professor- 
ships at Woodstock, Yt., Pittsfield, Mass., Dartmouth, 
Baltimore, Lexington, Louisville, and finally, in 1850, in 
the University of the City of New York. Of the numerous 
productions of his pen, the most noteworthy are the 
"Inquiry into the Degree of Certainty in Medicine," etc., 
Philadelphia, 1848; *'The History, Diagnosis, and Treat- 
ment of Typhoid and Typhus Fever," Philadelphia, 1842 ; 
and, "The History, Diagnosis, and Treatment of the Fevers 
of the United States," Philadelphia, 184t ; of which, three 
subsequent editions were issued. To these may be added 
his essay on the Philosophy of Medical Science, in which 
the importance of facts and observations is insisted on, and 
all theorizing is denounced, in accordance with the teach- 
ings of Louis. 

Dr. David Hosack, 1769-1835, a native of New York, 
graduated as Bachelor of Arts at Princeton in 1789, and as 
Doctor of Medicine in the University of Pennsylvania in 
1791. After practising a year at Alexandria, Ya., he spent 
two years in Edinburgh and London. Returning to New 
York, he entered into partnership with Dr. Samuel Bard, 
was appointed Professor of Botany in Columbia College in 
1795, to which was added the chair of Materia Medica, in 
1797. In 1807, he was chosen Professor of Surgery and 
Midwifery in the newly-formed College of Physicians and 
Surgeons of the State of New York, and in 1818, took the 
chair of Theory and Practice. In 1826, he resigned, with 
others, and went into the Rutgers Medical College. His 
writings appear in the philosophical transactions, in the 
"Medical and Philosophical Register," of which he was the 
founder, and as occasional lectures and pamphlets. They 
were collected and published as "Essays on various subjects 
in Medical Science," in three volumes, New York, 1824- 
1830. His "System of Nosology" reached two editions; 
his "Lectures on Theory and Practice" were edited by Dr. 



LITERATURE AND INSTITUTIONS. 809 

Diicachet, and published at Pliiladelpliia in 1838. His most 
important paper was his "Observations on Febrile Conta- 
gion," and on the means of improving the Medical Police of 
the City of Xew York, N. Y., 1820. As a lectnrer, editor, 
and writer, he exercised much influence on the profession, 
and his literary and scholarly tastes were imparted to his 
pupils, and especially to Dr. John W. Francis, who, after 
his graduation in 1810, becam.e associated with him in 
practice. Dr Francis was the son of a German grocer, 
born in New York, 1789, died 1861. He was for thirteen 
years Professor in the College of Physicians and Surgeons, 
and followed Dr. Hosack to Rutgers, the close of which 
ended his career as a teacher. 

Dr. Joseph Mather Smith, 1789-1866, graduated at the 
College of Physicians and Surgeons in 1815, and was Pro- 
fessor of Theory and Practice of Physic, same school, 1826 
to 1855, when he took the chair of Materia Medica. He 
contributed largely to literature through the medical jour- 
nals; presented some interesting reports to the American 
Medical Association, and published "Elements of Etiology," 
a "Philosophy of Epidemics," Xew York, 223 pages 8vo. 

For beauty of style as a writer and lecturer, Dr. Samuel 
Henry Dickson is pre-eminent. Born in Charleston in 1798, 
he graduated at Yale in 1814, and in ^Medicine at the 
University of Pennsylvania in 1819; was Professor in the 
Charleston Medical School from 1824 to 1831, 1838-34, 
1850-7; in the Xew York University, 1847-50; and in 
the Jefferson School, 1858; he died March 31, 1872. His 
systematic works were not very successful, or worthy of 
special remark, but his journal contributions, and especially 
his volumes of essays, are among the most attractive litera- 
ture of medicine. 

John K. Mitchell, born in Virginia, 1793, took his 
academical degrees at the University of Edinburgh, com- 
menced his medical studies under Dr. Chapman in 1816, 



310 LITERATURE AND INSTITUTIONS. 

and graduated in medicine at the University of Pennsylvania 
in 1819. After three voyages to India and China, for the 
sake of his health, he returned to Philadelphia, and in 1822, 
began to deliver lectures on Medical Chemistry in the Sum- 
mer School. In 1841, he was elected to the chair of the 
Practice of Medicine in the Jefferson Medical College, which 
he filled to the date of his death in 1858. As an original 
investigator, and clear logical reasoner, his name stands 
among the highest, and is probably destined to a higher 
relative position in the future, than it enjoys even now. 
His papers on Endosraosis, Mesmerism, Ligature of Limbs 
for Spasm, and Cryptogamous Origin of Fevers, will be 
consulted, not only for the original facts which they set 
forth, but as models of suggestiveness, if the phrase may be 
permitted. 

Dr. Charles Friek, born at Baltimore August 8, 1823, 
received the degree of Doctor of Medicine from the Univer- 
sity of Maryland in 1845. In 1856, he was chosen to the 
chair of Materia Medica in the Maryland College of Phar- 
macy, and in 1858, he became Professor of Materia Medica 
and Therapeutics in the University of Maryland. His most 
valuable contributions to literature are his " Analysis of the 
Blood," American Journal of the Medical Sciences, January, 
1848; "Treatise on Renal Diseases," 1850; "On Diabetes," 
A'nerican Journal of the Medical Sciences, 1852; "On 
Urinary Calculi," American Medical Monthly, April, 1858. 
He died March 25, 18G0, of Diphtheria, contracted from a 
patient upon whom he had performed the operation of 
Tracheotomy five days previous. All his papers are care- 
ful, conscientious reports of original observations, with the 
least possible amount of theory, and with direct reference to 
practice. 

Among the diseases which have received the greatest 
amount of attention in this country may be mentioned yellow 
and malarial fevers, and diseases of the chest. Our litera- 



LITERATURE AND INSTITUTIONS. oil 

ture on yellow fever includes over one hundred books and 
pamphlets, besides more than six hundred journal articles. 
It was the epidemic of this disease along the North Atlantic 
coast which gave the first impetus to medical authorship in 
this country, and produced a mass of controversial writings 
which, although of little value in a scientific point of view, 
were useful, as giving their authors the habit of writing for 
the press. The earlier books have already been referred to, 
but mention should be made of the writings of Felix Pascalis 
Ouviere, generally known under the name of Pascalis. Dr. 
Pascalis was a native of Provence, France, and was born 
about 1750. Having graduated in medicine at Montpellier, 
he went to St, Domingo, and there practised his profession 
until driven out by the Revolution of 1T93, when he came 
to Philadelphia, and subsequently settled in New York, 
where he died in 1833. Besides his works on Yellow Fever, 
he wrote a treatise on Syphilis, New York, 1812, and con- 
tributed papers to journals. He was one of the editors of 
the Medical Repository. 

Another writer on Yellow Fever who seems to be little 
known except in the South is Dr. J. L. E. W. Shecut, a 
native of South Carolina, born in Beaufort, 1770; died in 
Charleston, 1836. He studied under Dr. Ramsay, of 
Charleston, graduated M.D. at Philadelphia in 1791, and 
at once commenced practice in Charleston.^ His most im- 
portant essays were collected and published in one volume, 
Charleston, 1819, under the title of " Shecut's Medical and 
Philosophical Essays." Tliis book, which is quite rare, con- 
tains his account of the yellow fever of 1817, first published 
in that year, and also his "Essays on Contagions and Infec- 
tions," first published in 1818, and should be consulted by 
those who wish to trace the history of opinions in the South 
relating to this disease. 

' For these data I am indebted to Dr. Robert Lebby, of Charleston. 



312 LITERATURE AND INSTITUTIONS. 

The principal work on Yellow Fever, which includes the 
information of all others of a prior date, is that of Dr. Rene 
la Roche, published in 1855. Dr. La Roche was of French 
descent, born iti Philadelphia, in 1795, his father being an 
emigrant from St. Domingo. Unlike the majority of promi- 
nent American physicians, he was not connected with a large 
medical school, and his justly deserved reputation rests 
entirely upon his writings, and especially on his treatise on 
Yellow Fever, which is a model of research, and is remark- 
able, not only for the number, but the accuracy of its refer- 
ences, nnd the impartiality with which opposing statements 
are given. 

The most valuable recent articles on this disease are in 
the New Orleans and the Charleston Medical Journals, but 
the great majority oi them are historical and controversial. 

During the course of an epidemic, physicians are too busy 
to make observations which require much time or care, or 
to make more than brief notes. The papers of Drs. Faget,^ 
Logan, ^ and Sternberg,^ giving temperature observations,, 
make an advance in the right direction, but we lack data as 
to the pathological chemistry of the disease, and as to its 
relations with the malarial fevers. With regard to this last 
class of diseases, our literature is even more extensive than 
that of the preceding, and occupies much space in the jour- 
nals of the West and South. 

Our most valuable contribution to the natural history of 
malarial disease is the treatise of Dr. Daniel Drake, on the 
principal diseases of the Interior Valley of North America. 
This work is the "Magnum Opus," and results of the life- 
long labour, including extensive personal observations, 
literary research, and matured reflection, of a man whose 

' New Orleans Med. aud Surg. .Journal, 1873, i., N. S., p. 145. 

2 Do. do. 1874, ii. p. 779. 

3 Anier. Jour. Medical Sciences, 1875, Ixx. p. 9D. 



LITERATURE AND INSTITUTIONS 313 

fame, as cotiipared with that of his contemporaries, will 
probably be greater a century hence than it is to-day, and 
vvh{)se name, even now, should be among the first on the list 
of the illustrious dead of the medical profession of the United 
States. The son of an illiterate Kentucky pioneer, brought 
up in a log cabin, attending a country school in the winter, 
and using the remainder of the year working on a farm, he 
surmounted the obstacles thus placed in his way, and by 
unceasing labour, joined to a sound common sense, which 
rose to the level of genius, took a leading position as author, 
editor, practitioner, and teacher. Commencing the study 
of medicine at the age of sixteen, he attended his first course 
of lectures in 1805, and his second in the University of 
Pennsylvania, in 1815, at the end of which he graduated. 
He was Professor successively in the Transylvania School, 
the Medical College of Ohio; a second time in the Transyl- 
vania; the Jefferson School; the Medical Department of 
Cincinnati College; the University at Louisville; and again 
in the Medical College of Ohio. He died November 6, 
1852. His first publication was a pamphlet on the climate 
and diseases of Cincinnati, published in 1810, and reissued 
as " The Natural and Statistical View or Picture of Cin- 
cinnati and the Miami Country," published in 1815. This 
work is quite rare, and is interesting as being the germ from 
which sprung his great work above referred to. 

He founded the "Western Journal of the Medical and 
Physical Sciences," which would be of much value, if for 
no other reason, on account of a series of essays on Medical 
Education, by Dr. Drake, which were published in it. These 
essays were issued in a separate volume, in 1832, and form 
upon the whole, the most satisfactory contribution to this 
vexed question which this country has ever produced. He 
commenced the preparation of his work on the diseases of 
the Mississippi Valley in 1822, and the second volume was 
not issued until after his death. Very few of the younger 
2T 



314 LITERATURE AND INSTITUTIONS. 

physicians of this country are familiar with his writings. 
Of his essays on Medical Education and Diseases of North 
America, no second editions have been published; but if 
there are any books to which the hackneyed phrase of the 
reviewer, ''No physician's library is complete without it," 
apply, it is to these works of Dr. Drake, as far as American 
physicians are concerned, and they are most distinctively 
and peculiarly American books, in subject, mode of treat- 
ment, and style of composition. 

The dissertation of Dr. J. K. Mitchell "On the Crypto- 
gamous Origin of Malarious and Epidemic Fevers," is an 
ingeiiious piece of reasoning, and presents a summary of 
all the d. priori arguments in favour of this theory which can 
be advanced. The papers of Dr. Salisbury on the same 
subject are without value. 

TJi)on the subject of diseases of the chest the most note- 
worthy monographs have been the works of Morton, Mc- 
Dowell, Lawson, and Flint on Consumption; of Horace 
Green on the Diseases of the Air-passages ; La Roche on 
Pneumonia, and of Gerhard and Flint on Diagnosis of Dis- 
eases of the Chest. The treatise on Phthisis, by Dr. L. M. 
Lawson, adds another to the numerous examples of careful 
studies by physicians of diseases with which they are them- 
selves afflicted. Dr. Lawson was a native of Kentucky; 
born 1812, died 1864. His early education was defective. 
At the age of twenty he was licensed to practise, but it was 
not until 1838 that he obtained his diploma from the 
Transylvania School. In 1844 he was elected to a Profes- 
sorship at Lexington ; from 1847 to 1853 he filled the 
chair of Materia Medica in the Medical College of Ohio, 
and then became Professor of Principles and Practice of 
Medicine. During the winter of 1859-60, he lectured on 
Clinical Medicine in the University of New Orleans. He 
founded, and for a long time conducted, the "Western 
Lancet," in which many of his lectures were published. 



LITERATURE AND INSTITUTIONS. 315 

Dr. W. W. Gerhard, 1809-72, was a native of Philadel- 
phia, and a graduate of the University of Pennsylvania. 
After taking his degree he spent two years in Paris, and 
became thoroughly indoctrinated with the teachings of 
Louis. On his return to Philadelphia he was appointed 
lecturer at the Medical Institute, and Assistant Clinical 
Lecturer to Professor Jackson. For tvventy-5ve years he 
was the senior Physician to the Pennsylvania Hospital. 
Some of his clinical lectures appeared in the "Medical 
Examiner," of which he was one of the editors. His prin- 
cipal work was his "Treatise on Diagnosis of Diseases of 
the Chest," Philadelphia, 1842; second edition, 1846. 

Dr. Horace Green, 1802-1866, was a native of Vermont, 
and a graduate of Castleton Medical College in 1824. From 
1840 to 1843 he was Professor of Theory and Practice in 
the same school; and in 1850 took the same chair in the 
New York Medical College, of which he was one of the 
founders, continuing to lecture until 1860. In connection 
with this school he established, with his colleagues, the 
"American Medical Monthly." He was the first in this 
country to devote himself to a specialty, and his works on 
the local treatment of diseases of the air-passages attracted 
much attention, although they are not of a character to add 
permanently to his fame. 

In medical jurisprudence, the systematic works of Beck, 
and Wharton and Stille, and the treatise of Dr. Wormley 
on Poisons, are the most important, and each of them com- 
pares most favourably with any similar works in existence. 

There are probably not to be found in the annals of medi- 
cine so large and valuable contributions to its literature by 
three brothers, as w*ere made by the Beck family of Xew 
York. 

John B. Beck, 1794-1851, graduated in Columbian Col- 
lege in 1813, became a pupil of Dr. Hosack, and graduated 
in Medicine at the College of Physicians and Surgeons in 



316 LITERATURE AND INSTITUTIONS. 

ISn, presenting, as a thesis, a paper on Infanticide, which 
was pnblished, iind is still a standard work on this subject. 
In 1822 he assisted in establishin<i^ tlie "New York Medical 
and Physical Journal,'^ with which he was connected for the 
next seven jenrs, and in which he pnblished numerous arti- 
cles. In 1826 he became Professor of Materia Medica in 
the College of Physicians and Surgeons, just newly organ- 
ized. His principal works, in addition to those already 
alluded to, were his "Essnys on Infant Therapeutics," New 
York, 1849; second edition, 1855; and his Historical 
Sketch of the State of Medicine in the American Colonies; 
"Lectures on Materia Medica, '^ and a collection entitled, 
"Researches in Medicine and Medical Jurisprudence ^' 

Theodoric Ptomeyn Beck, 1791-1855, graduated at Union 
College, Schenectady, studied under Dr. Hosack, and 
graduated as M.D. at the College of Physicians and Sur- 
geons, in 1811. He was appointed Professor of the Insti- 
tutes of Medicine and Medical Jurisprudence in the College 
at Fairfield, in 1815. In 1817 he became Principal in the 
Albany Academy, and gave up the practice of medicine. 
In 1840 he took the chair of Materia Medica in the Albany 
Medical College, which he held until 1854. His great work 
was his treatise on Medical Jurisprudence, which appeared 
in 1823, in two volumes, and of which, includingfour English 
editions, ten editions were issued during the author's life. 

Dr. Lewis C. Beck, 1798-1853, the younger brother of 
the preceding, studied medicine under Dr. Dunlop, and was 
admitted to practise in 1818. In 1826 he was elected Pro- 
fessor of Botany and Chemistry in the Vermont Academy of 
Medicine. This position he resigned in 1832. In 1836 he 
was appointed Mineralogist to the Geological Survey of the 
State of New York, and in 1840 was elected Professor of 
Chemistry and Pharmacy in Albany Medical College. His 
contributions to medical literature, to chemistry, meteoro- 
logy, and mineralogy, were numerou,^. His princi[tal medical 



LITERATURE AND INSTITUTIONS. 317 

work was his Report on Cholera, made to the Governor of 
New York in 1832. 

The literature of obstetrics has been so fully given by Dr. 
Thomas, in a preceding article of this series, that further 
reference to it is superfluous. We will add only, with regard 
to Dr. Hugh L. Hodge, that he was a graduate of Prince- 
ton, a pupil of Dr. Wistar, and that his early taste was for 
surgery rather than obstetrics. He was induced to chnnge 
his specialty by Dr. Dewees. He was afflicted with defec- 
tive vision, which increased with age, and liis great work 
on Obstetrics was produced entirely by dictation. He 
commenced as a lecturer in the Medical Institute, and was 
elected Professor of Obstetrics in the University of Penn- 
sylvania in 1835, the rival candidate being Dr. Charles D. 
Meigs, a lecturer in the Philadelphia Association for Medi- 
cal Instruction, who six years later obtained the chair of 
Obstetrics in the Jefferson School. The literary works of 
Dr. Meigs compare very unfavourably with those of his rival 
as to scientific value and exactness, but they are much more 
attractive to students and those who read for pleasure rather 
than instruction. 

We have three names of American medical writers whose 
works should be mentioned here, viz., Coxe, Watson, and 
Dunglison. 

Dr John Redman Coxe, 1773-1864, was a type of the 
medical scholar, who loves books for their own sake, and 
who takes more pleasure in discovering a forgotten sentence 
in a folio of the fifteenth century than in original investiga- 
tions in the light of the present day. Born in Trenton, 
New Jersey, he completed his classical education at Edin- 
burgh, studied medicine under Dr. Rush, and took his 
degree of M.D. at the University of Pennsylvania in 1794, 
after which he continued his medical studies in London, 
Edinburgh, and Paris for about two years. He was elected 
Professor of Chemistry in the University of Pennsylvania in 

27* 



318 LITERATURE AND INSTITUTIONS, 

1809, and of Materia Medica and Pharmacy in 1818. He 
filled the latter chair until 1835, at which date he retired, 
and was but little known thereafter. His Dispensatory^ and 
Medical Dictionary'^ were useful compilations, and met an 
existing want. His Observations on Vaccination^ was his 
best original contribution to medicine. His Inquiry on the 
Discovery of the Circulation of the Blood was a paradoxical 
attempt to disprove the claims of Harvey. His last work, 
and the one most in accordance with his tastes, was "The 
Writings of Hippocrates and Galen," Philadelphia, 1846. 
He founded the first medical journal published at Philadel- 
phia, preceding that published by Dr. Benj. Smith Barton 
by two months, and his library was, in its day, the best col- 
lection of ancient authors on medicine in this country. 

Dr. John Watson, of New York, has been alluded to in 
the article on surgery. His literary tastes led him to his- 
torical studies and the collection of a valuable library, and 
his historical sketch of ancient medicine-* shows that he con- 
sulted and enjoyed consulting the original works of the 
fathers in medicine. 

Dr. Robley Dunglison, a native of Keswick, England, 
born in 1798, was one of the most prolific of medical 
authors. He obtained his medical education at Edinburgh, 
Paris, and London ; settled in the latter city, where he wrote 
a treatise on the dis-eases of children [1824], and was one of 
the editors of the London Medical Repository in 1823-24. 
In 1824 he accepted the invitation of Thomas Jefferson to 
fill the chair of Anntomy, Physiology, Materia Medica, and 
Pharmacy, in the University of Virginia. At this place he 
published in 1827 a syllabus of his course on Medical Juris- 

' The American Dispensatory. Phila., 1806, 4tli ed. 1818. 

2 The Philadelphia Medical Dictionary. Phila., 1808, 2d ed. 1817. 

3 Practical Observations on Vaccination. Pljila., 1802. 

4 The Medical Profession in Ancient Times. 8vo., N. Y., 1856. 



LITERATURE AND INSTITUTIONS. 319 

prudence and prepared his Medical Dictionary. In 1833 he 
took the chairs of Materia Medica, Therapeutics, Hygiene, 
and Medical Jurisprudence in the University of Maryland, 
and from 1836 to 1868 was Professor of the Institutes of 
Medicine in the Jefferson School. He died April 1, 1869. 
His Systems of Physiology (first edition 1832), Hygiene 
(first edition 1835), Tiierapeutics (1836), Practice (1842), 
and Materia Medica (1843), were popular in their day, 
nearly all of them passing through several editions. The 
work l3y which he will be rememl)ered is his Medical Dic- 
tionary. The first edition of this was published at Boston 
in 1833, in two volumes. A peculiarity of this edition is 
that it contains brief biographical sketches of physicians, 
omitted in subsequent issues. The last edition, Philadelphia, 
1874, edited by his son, is the most convenient work of the 
kind in existence. 

Our literature on insanity and the pathology of mental 
disease is insignificant in comparison with the importance 
of the subject and the opportunities existing for its study, 
the only monograph of permanent value being the "Con- 
tributions to Mental Pathology," by Dr. Isaac Ray, 8vo., 
Boston, 1873. Considering the number and size of the 
asylums for the insane in this country, and the amount of 
money which has been spent upon them, it is rather curious 
that the medical officers connected with them should have 
contributed so little to the diagnosis, pathology, or thera- 
peutics of diseases of the nervous system. An examination 
of the works relating to this subject, and more especially 
of the American Journal of Insanity, which is the most 
important, and which contains the transactions of the Asso- 
ciation of American Superintendents of Hospitals for the 
Insane, will show that the thoughts of these specialists have 
been mainly directed to the subjects of construction and 
management of asylums and to the jurisprudence of insanity. 
This last sul>ject is one of great and increasing importance; 



320 LITERATURE AND INSTITUTIONS, 

but our contributions to its literature consist ratlier of 
opinions and ontological speculations than of scientific 
observations. The annual reports of Dur insane asylums 
consist, for the most part, of business and financial statistics, 
and are intended for the use of appropriation committees 
rather than of physicians. There are some signs, however, 
that more attention will hereafter be given to recording of 
the physical phenomena of mental disense, and it is to be 
hoped that we may soon have some published results from 
the pathological department of the Utica Asylum, which 
will stimulate other institutions to undertake similar work. 
No more promising field to-day exists in medical science for 
valuable discoveries than in the wards and laboratory of a 
large, well-appointed hospital for the insane. 

Upon the subject of hygiene no systematic work has yet 
been produced in this country, with exception of the treatise 
on Military Hygiene, by Dr. Hammond. One of the prin- 
cipal writers in this department was Dr. John Bell, a native 
of Ireland, 1796-1875. He came to this country with his 
parents, who settled in Virginia in 1810, and graduated in 
medicine in the University of Pennsylvania, after which he 
lectured for some years in the Philadelphia Medical Insti- 
tute, and for two years in the Medical College of Ohio. His 
treatise on Baths and Mineral Waters is the only compre- 
hensive and respectable treatise on this subject published 
in this country. The most important contributions to the 
literature of hygiene which we have produced are the reports 
of the various State and municipal boards of health, most 
of which, however, are of comparatively recent origin, and 
it is to be hoped are oniy just fairly commencing their 
career of usefulness. 

The subject of hospital construction and hospital hygiene 
has been much discussed in this country, the latest produc- 
tion being a large and handsomely illustrated work published 
by the trustees of the Johns Hopkins Hospital of Baltimore. 



LITERATURE AND INSTITUTIONS. 321 

The publications of our municipal, State, and natioiial 
governments, relating to vital and medical statistics, are 
among our most valuable contributions to medical literature. 
The reports of city and State boards of health show each 
year evidences of more careful investigation into the proba- 
ble causes of disease and the means of removing or dimin- 
ishing them, and the necessity and economic value of such 
work is slowly but steadily becoming apparent to the edu- 
cated classes of the community by means of the publications 
referred to. 

The circulars and reports of the medical department of 
tlie army are sufficiently well known, and within the last 
few years a series of reports have been commenced by the 
Medical Department of the Navy and by the Marine Hospital 
Service of the Treasury Department, which it is to be hoped 
will become important additions to our medical literature, 
not only in regard to statistics, but in the departments of 
hygiene, pathology, and therapeutics. It should not be for- 
gotten by the physicians of the United States that they are, 
to a certain extent, responsible for the condition of the 
medical departments of the government, since the sympathy 
and opinions, expressed or implied, of the medical profession 
at large as to the work which these departments have done, 
or are trying to do, furnish the encouragement and stimulus 
which are necessary to the continuous production of good 
results, and also influence to a considerable extent the action 
of our legislators with regard to the officers of these depart- 
ments. 

The reports of the Surgeon-Generals of the Army, the 
Navy, and the Marine Hospital Service, while ostensibly 
presented to the Secretaries of War, the Navy, and the 
Treasury, are really, in a sense, made to the physicians of the 
country, who are the only competent judges as to whether 
the work is satisfactory, and commensurate with the means 
which have been allowed for its performance. 



322 LITERATURE AND I N'ST ITUTIOXS. 

Of encyclopedic works, the result of the combined labonp 
of many authors, like the great French dictionaries, but one 
specimen has been attempted in this country. This was the 
American CyclopjEdja of Practical Medicine and Surgery, 
edited by Dr. Isaac Hays, of which two volumes, completing 
the letter "A" were published at Philadelphia in 1834-36, 
and reissued with a new title, "Medical and Surgical 
Essays," in 1841. The time is perhaps not far distant when 
a first-class publication of this character will be sufficiently 
in request in this country to warrant an attempt at its pro- 
duction. 

Reprints and Translations. — The second class of medical 
works referred to in our statistics, iuclodes the reprints and 
tran>lations, which cannot be overlooked in an account of 
our medical literature, since they have formed an important 
part of the libraries of American physicians, even if quantity 
only be considered. 

Prior to the Declaration of Independence, the largest and 
most important medical book printed in this country was 
the "Lectures on Materia Medica," of Cullen, issued at 
Philadelphia in iTTo, in -Ito., and advertised as "The very 
cream of physic," and as "absolutely necessary for all 
American physicians who wish to arrive at the top of their 
profession."^ 

In 17 76 was published, at Philadelphia, the treatise of 
Tan Swieten on the Diseases Incident to Armies, with 
Ranby on Gunshot Wounds, and Northcote on Xaval Snr- 
gery, forming a small volume of 164 pages, which is usually 
found bound with the second edition of John Jones' " Prac- 
tical Remarks," etc., of the same date, and was probably the 
principal guide of the army surgeons daring the Revoiu- 

* A copy of this work was purchased bj the Library of the Penn- 
sylvania Hospital 17S0, for £133 bs. currency, equal to £1 15*. 

specie. 



LITERATURE AND INSTITUTIONS. 323 

tionary War. Cnllen's "First Lines of the Practice of 
Physic'" was reprinted from a smuggled copy, in 1781, at 
Philadelphia, in two volumes, 8vo. , and five later American 
editions, the last edited, with a great flourish of trumpets, 
by Dr. Caldwell, in 1822, attest its popularity. 

For thirty years after the Declaration of Independence, 
the majority of the reprints were works of English and 
Scotch writers, and especially of the Edinburgh school, the 
favourite authors being Cullen, Brown, John Hunter, 
Benjamin Bell, Denman, Smellie, Hamilton, Beddoes, and 
Robert Jackson. The largest edition sold was probably of 
the "Edinburgh New Dispensatory." The only translations 
of French or German medical works issued in this country 
prior to 1800 were, Swediaur on Yenereal, New York, 1788, 
and Blumenbach's "Elements of Physiology," Philadelphia, 
1795. The first medical book printed in Louisiana was 
"Medicaments et precis de la Methode de M. Masdevall," 
a pamphlet of 48 pages, relating to the yellow fever, issued 
in 1796. 

The beginning of the influence of the French schools, 
w^iich for the next fifty years was so powerful in the United 
States, especially in surgery, is marked by the editions of 
Boyer and Desault, Philadelphia, 1805, to which rapidly 
succeeded the works of Alibert, Richerand, and Bichat. In 
this connection may be permitted a reference to two works 
which are omitted from our statistics, since they were in- 
tended for non-professional use, but which had an extensive 
sale, and indirectly exerted a very considerable influence, 
viz.,Buchan's Domestic Medicine, of which several editions 
were issued, the most important being that of Philadelphia, 
1795, revised by Dr. S. P. Griffitts, and the "Primitive 

' A copy of this work was purchased by the Library of the Penn- 
sylvania Hospital, 1780, for £135 5s. currency, equal to £1 155, 
specie. 



324 LITERATURE AND INSTITUTIONS. 

Physic," of John AVesley, of which there are several Ameri- 
can editions of the last century. 

Many foreign medical works have been issued in this 
country in connection with periodicals, such as the " Regis- 
ter and Library of Medical and Chirurgical Science," pub- 
lished at Washington, D. C, 1833-36, in which were issued 
" Bell on the Nerves," "Lawrence on the Eye," Yelpeau's 
Surgery, etc. ; The Select Medical Library, edited by John 
Bell; the American Medical Library, published under the 
supervision of Dr. Dunglison ; and the "Medical News and 
Library," in which some valuable books have been issued. 

The number of translations of French medical works 
which have been published in this country is one hundred 
and forty-eight (148). One hundred and one of these were 
issued prior to 1842, and only eight have appeared within 
the last ten (10) years. 

The number of translations of German works issued has 
been sixty-four (64), of which but fourteen (14) were issued 
prior to 1842, and twenty-eight (28) within the last ten 
years. 

The number of reprints of English medical books has been 
five hundred and eighty-four (584), thirty (30) of these were 
issued prior to 1800 ; two hundred and seventeen (217) 
during the next forty years, and three hundred and thirty- 
seven (337) since 1840, the production gradually increasing. 

It is largely to French and German sources that we owe 
our works on pathology, pathological anatomy, pathological 
chemistry, and physiology. 

The best systematic treatise on the practice of medicine 
from the German, published in this country, was that of 
Niemeyer, in 1869, the name of the author having been 
made somewhat familiar to the American public by a 
translation of his lectures on Phthisis, published the year 
previous. The works of Billroth on General Surgical 
Pathology, New York, 1871, Rindfleisch, a Text- book of 



LITERATURE AND INSTITUTIONS. 325 

Pathological Histology, Philadelphia, 1872, are the books 
which are to-day directing the work of the younger profes- 
sional men of the country. The Cyclopaedia of the Practice 
of Medicine, edited by Ziemssen, now in course of publica- 
tion, is the most extensive medical work, native or foreign, 
which has ever been issued in the United States, and is 
probably destined to exercise great influence upon our inves- 
tigation of diseases, whatever it may do for the practice. 

Of the translations from the French, the most important 
have been those relating to anatomy, physiology, and sur- 
gery. The favourite authors have been Bichat, D. J. 
Larrty, Boyer, Orfila, Magendie, Laennec, Cazenave, 
Baudelocque, Louis, Yelpeau, Broussais, Cazeaux, Colom- 
bat, Ricord, Yidal, and Malgaigne. 

It would be useless to give lists of the titles of these; it 
is sufficient to say that they include nearly every important 
monograph or text-book produced by English writers: from 
Cullen, Brown, and Darwin, to Bennett, Watson, and Ait- 
ken ; from John Hunter, Benjamin, Jahn and Charles Bell, 
Pott, Hey, and the Coopers, to Erichsen, Paget, and 
Holmes; and from Hamilton and Smellie to Simpson, 
Barnes, and Duncan. The works of nearly all the great 
English teachers have been quickly reproduced on this side 
of the water, and their modes of treatment are those fol- 
lowed by the majority of our practitioners. 

A few medical books have been printed in Spanish at 
Philadelphia, for the Mexican trade, including the " Com- 
pendio de la Medecina," by J. M. Yenegas, 1827. The 
number of reprints in this country has been largely due to 
the want of an international copyright law, for which reason 
publishers found it much cheaper to take the work of an 
English author gratis, than to pay an American writer for 
his MS. Sometimes the name of an American physician is 
given as editor of the reprint, but in most cases, this means 
little more than that he approves the book, the so-called 
28 



326 LITERATURE AND INSTITUTIONS. 

editing being imperceptible. To this remark a few honour- 
able exceptions should be made, such as the additions by 
John Bell to the lectures of Stokes, of Gerhard to Graves; 
the reprints of Copland's Dictionary, in which the biblio- 
graphical additions, made by Dr. Charles A. Lee, are 
numerous and valuable, the editions of Yelpeau's Surgery 
by Mott and Blackman, and the editions of Aitken's Prac- 
tice by Dr. Clymer, who has added much to the complete- 
ness of the work. 

This so-called editing was the subject of some caustic 
criticism, and has of late years almost entirely disappeared. 
With regard to the merits of the International Copyright 
question, there has been much discussion. On the one side, 
it is truly said that the desire for books increases by the 
supply, and that the sale of the cheap reprints produces a 
market for indigenous productions. On the other side, it 
is affirmed with equal truth, that it deprives our own writers, 
to a great extent, of pecuniary inducements to labour. The 
question is one to be decided, however, by the laws of mo- 
rality rather than expediency, and the majority of educated 
non-interested parties agree that the passage of an interna- 
tional copyright law would be an act in accordance with the 
dictates of common honesty and justice. 

Undoubtedly, the cheapness and abundance of these re- 
publications have done much to diffuse knowledge among 
our practitioners, and the libraries of many physicians have 
been mainly comp'osed of the " pepper and salt sheepskin 
covered Philadelphia reprints." Of late years there has 
been a marked improvement in the quality of paper and 
typography of our medical books, while the stout bindings 
of sheep and calf of fifty years ago, have been largely super- 
seded by the more showy, but, at the same time, more flimsy 
cloth bindings now in vogue. The German fashion of 
publication in parts has been almost unknown, except as 



LITERATURE AND INSTITUTIONS. 321 

connected with periodicals, and it is to be hoped that it 
may be long before the annoyance and confusion which 
attend the Lieferung and Hefte may be connected with 
our medical publications. " The American Clinical Lec- 
tures," edited by E. C. Seguin, and published by G. P. 
Putnam & Sons, look in this direction most unpromisingly, 
and the publication of such totally unconnected papers, in 
a series of continuous paging, even if special paging is added, 
must be unhesitatingly condemned by all who have occasion 
to either make or to verify bibliographical references to 
them. 

It may be of interest to refer to some statistics of the 
locality of publication of these works. Of class one (I) we 
find that three hundred and seventy-three (373) first editions 
were published in Philadelphia, one hundred and seventy- 
three (173) in New York, eighty-one (81) in Boston, 
twenty-four (24) in Cincinnati, sixteen (16) in New Orleans, 
and fifteen (15) in Baltimore, leaving ninety-six (96) pub- 
lished elsewhere. If each edition be reckoned as a separate 
work, we find that six hundred and thirteen (613) have 
appeared in Philadelphia, two hundred and twenty-six (226) 
in New York, ninety-six (96) in Boston, and eighteen (18) 
in Baltimore. Of the reprints and translations, six hundred 
and eighteen (618) books, or seven hundred and fifty-three 
(753) editions have been issued from Philadelphia, one 
hundred and seventy-seven (177) books, or two hundred and 
nineteen (219) editions from New York, eighty (80) from 
Boston, and ninety-four (94) elsewhere. It appears then 
that more than one-half of our medical books have been 
published in Philadelphia, and about one-fifth in New York. 
The firm of Carey, Lea & Carey, now H. C. Lea, has pub- 
lished nearly six hundred editions of medical works ; and 
those of Lindsay & Blakiston, and Lippincott, each between 
one and two hundred. In New York, the principal pub- 



328 LITERATURE AND INSTITUTIONS. 

lishing house is that of S. S. & W. Wood, now Wm. Wood 
& Co., which has issued about one hundred and fifty (150) 
editions.^ 

Medical Journals. — It is not in text-books or systematic 
treatises on special subjects that the greater part of the 
original contributions to the literature of medicine have 
been first made public during the last century, either in this 
or other countries. Since the year 1800 medical journalism 
has become the principal means of recording and communi- 
cating the observations and ideas of those engaged in the 
practice of medicine, and has exercised a strong influence 
for the advancement of medical science and education. 

To this class of literature this country has contributed a 
noteworthy share. Excluding those devoted to dentistry, 
pharmacy, popular hygiene, and "isms" of various kinds, 
we find that one hundred and ninety-five medical journals 
have been commenced in this country, including reprints of 
foreign journals, making in all one thousand six hundred 
and thirty-seven volumes, or a greater bulk than the text- 
books and monographs. 

Prior to the establishment of medical periodicals, there 
was little or no encouragement or opportunity for a physi- 
cian to record his observations. The professor in a medical 
school might, in an introductory notice to the thetsis of one 
of the students — the so-called programma or propempticon 
inaugurale — make a statement, not to exceed sixteen pages 
upon any subject, whether connected with that treated of 
in the thesis or not, and sometimes such a paper was con- 
tinued through the programraata of twenty or thirty dif- 

1 The figures of this distribution among publishers are only an 
approximation, and are probably too small, since the publishers' 
names are not stated in many of the lists of books from which titles 
have been derived. 



LITERATURE AND INSTITUTIONS. 329 

ferent dissertations, making it very difficult at the present 
day to secure the entire worli. 

But if the country doctor had a communication to make 
to his brethren, he must either do it by a pamphlet printed 
at his own expense, or must forward it to some one connected 
with a medical school or scientific association, and trust to 
him that it should be made known and recorded. The pro- 
fessors themselves, as was natural, gave the greater part of 
their thought and labour to their systems, theories, and 
commentaries. 

It was the day of large books, and unless one could pro- 
duce a volume, he received little encouragement to write. 
At the present day, the demand for brief papers and reports 
of single cases, exceeds the supply. 

The weekly and monthly periodicals are omnivorous and 
insatiable in their requests for contributions Through the 
medical journals have been given to the world nearly all the 
discoveries which the science and art of medicine owes to 
American physicians. They furnish the original data which 
are the foundations of monographs and text-books, and their 
files remain interesting and valuable when the latter have 
become obsolete and are forgotten. 

Medical journalism in the United States presents some 
peculiarities, although not nearly so many as is commonly 
supposed, and has been the subject of severe, and, to some 
extent, merited criticism ; but while it includes some of the 
worst, it also contains the best of our medical literature, 
and some details as to its rise, progress, and character, may 
therefore be of interest. 

The first medical journal printed in this country was a 
selection and translation from the "Journal de Medecine 
Militaire," issued in Paris from 1782 to 1788. This trans- 
lation was published in New York about 1790, forming a 
volume of one hundred and twenty pages Svc, which is 

28* 



330 LITERATURE AND INSTITUTIONS. 

quite rare.^ The original journal from which this is made 
up is one that is valuable to the army surgeon ; and the 
reprint is here referred to as being the first medical journal 
printed in the United States, and because the fact of its 
existence is probably known to very few. 

The first American medical journal was a quarterly, " The 
Medical Repository," edited by S. L. Mitchell, Edward 
Miller, and E. H. Smith, and published at New York, from 
1797 to 1824. That this met an existing want is shown 
by the fact that the demand for the earlier volumes was 
sufficient to warrant the issue of a second edition of the first 
and second volumes in 1800, and a third edition of the same 
volumes in 1804-5. 

Dr. Elihu H. Smith, the projector of this journal, was 
born in Connecticut in 1771, graduated at Yale in 1786, 
and died in 1798. Although so young, he had edited 
several works, and contributed largely to literary periodicals, 
as well as to his own medical journal. 

Dr. Samuel L. Mitchell, 1764-1831, studied under Dr. 
Bard, and graduated in medicine at Edinburgh, in 1786. 
As Professor of Chemistry and Natural History in Columbia 
College, and from 1820 to 1826 of Materia Medica and 
Botany, chief editor of the '* Medical Repository," repre- 
sentative in Congress in 1801-4, and 1810-13, and United 
States Senator, 1804-9, he lectured and wrote upon almost 
all subjects, and his papers are scattered through various 
periodicals at home and abroad. He was rather a naturalist 
than a physician, and has very properly been called a 
"Chaos of Knowledge." 

' "A Journal of the Practice of Medicine, and Surgery and Phar- 
macy in the Military Hospitals of France. Published bj order of 
the King. Reviewed and digested by M. De Home, under the 
inspection of the Royal Society. Annotated from the French by 
Joseph Brown. No. I., vol. i., New York: J. McLean & Co." 



LITERATURE AND INSTITUTIONS. 331 

Pr. Edward Miller, 1700-1812, was a native of Delaware, 
and a graduate of the Medical Department of the University 
of Pennsylvania in 1789. In 1807 he accepted the chair of 
the Practice of Physic in the College of Physicians and 
Surgeons, and in 1809 was appointed one of the Physicians 
to the New York Hospital. His writings were collected 
and published in one volume in 1814, the most important 
being his papers on Yellow Fever. 

The idea of the publication of the " Medical Kepository" 
was probably taken from the "Annals of Medicine" of 
Duncan, a continuation of the "Medical and Philosophical 
Commentaries of Edinburgh," and of which the " Edinburgh 
Medical Journal" of the present day is the successor. Al- 
though, owing to the tastes of Dr. Mitchell, it contains many 
dissertations which are now obsolete, the entire set of twenty- 
three volumes is even to-day well worthy of a place in the 
physician's library. At its close its subscribers passed to 
the "New York Medical and Physical Journal," and from 
that time. New York city has never been without a medical 
periodical. 

Thirty-one medical journals have been commenced in that 
city, besides nine devoted to specialties, and six reprints of 
foreign journals. The most important of these, in addition 
to those already named, are the "American Medical and 
Philosophical Register," edited by Drs. Hosack and Francis, 
1810-14; the " New York Medical Magazine," edited by 
Mott and Onderdonk, the "New York Journal of Medicine 
and Surgery," 1839-41, one of the best journals in this 
country, edited by Drs. Watson and Swett, the "New York 
Journal of Medicine," edited by Forry, Lee, Stephen Smith, 
and others, continued as the " American Medical Times," of 
virhich the "Medical Record" of to-day may be considered 
as the representative ; the " New York Medical Journal," 
edited successively by Drs. Hammond, Dunster, and Hunter, 
1865-76, and the "Archives of Scientific and Practical 



332 LITERATURE AND INSTITUTIONS. 

Medicine," edited by Brown-Sequard, 1873, which unfortu- 
nately ceased with its fifth number. The "Buffalo Medical 
Journal," edited by Dr. Austin Flint, 1845-60, and then 
merged in the "American Medical Monthly," is also a 
valuable series. 

The second medical journal published in this country was 
the "Philadelphia Medical Museum," edited by Dr. Coxe, 
1804-181 L, followed almost immediately by the "Philadel- 
phia Medical and Physical Journal," edited by B. S. Barton> 
and published at irregular intervals, 1804-1809. This 
journal, as was to be expected from the tastes of its editor, 
contains a large proportion of articles on natural history. 
Other well-known journals published in Philadelphia are the 
" American Medical Recorder," a quarterly, 1818-29, whose 
subscription list passed to the "American Journal of the 
Medical Sciences;" the "North American Medical and 
Surgical Journal," 1826-31; the "Medical Examiner," 
1838-56, which united with the "Louisville Review," form- 
ing the " North American Medico-Chirurgical Review," 
185*7-61 ; the " Medical and Surgical Reporter," 1856-76; 
the " Photographic Review of Medicine and Surgery," 
1870-72; and the "Philadelphia Medical Times," 1870-76. 

The most important journal on our list is the "American 
Journal of the Medical Sciences." This began as the " Phila- 
delphia Journal of the Medical and Physical Sciences," in 
1820, under the editorship of Dr. N. Chapman, who is said 
to have undertaken it under the stimulus of the phrase of 
Sidney Smith, so often quoted during the past year: "Who 
reads an American book?" In 1825 a new series began, 
edited by N. Chapman, W. P. Dewees, and J. D. Godman. 
This continued until 1827, when Dr. Isaac Hays, who had 
been associate editor in the last volume — number five of 
the new, or fourteen of the whole series — took charge of the 
Journal and gave it its present name. The ninety-seven 
volumes of this Journal need no eulogy, . They contain many 



LITERATURE AND INSTITUTIONS. 333 

original papers of the highest value; nearly all the real 
criticisms and reviews which we possess; and such carefully 
prepared summaries of the progress of medical science, and 
abstracts and notices of foreign works, that from this file 
alone, were all other productions of the press for the last 
fifty years destroyed, it would be possible to reproduce the 
great majority of the real contributions of the world to 
medical science during that period. It is evident that its 
editor has exercised a careful supervision over every part, 
but his personality is nowhere apparent, there being no 
editorial articles, and very few papers appearing over his 
signature. 

Baltimore produced the third of our medical journals, the 
"Baltimore Medical and Physical Recorder," edited by Dr. 
Tobias Watkins, 1808-9. This only reached number one 
(1) of the second volume, and it is somewhat curious tiiat 
of the ten medical journals and one reprint which have been 
commenced in that city, the duration of each has been 
comparatively brief. One little known may be referred to, 
" The Baltimore Philosophical Journal and Review," edited 
by Dr. J. B. Davidge, of which one number was published 
in 1823. It contains "a memoir on fractures of the thigh- 
bone," and "a case of extirpation of the parotid," each by 
the editor. 

The first medical periodical published in Boston was of 
a popular character, "The Medical and Agricultural Reg- 
ister," ISOG-t. The "New England Journal of Medicine 
and Surgery" began as a quarterly in 1812, and in 1828 
was consolidated with the "Boston Medical Intelligencer," 
and became a weekly, forming "The Boston Medical and 
Surgical Journal," which has continued to the present time. 
The original quarterly was well edited, and contains some 
valuable papers. Under the editorship of Dr. J. Y. C. 
Smith, which lasted for over fifty volumes, it would seem 
that no articles were ever refused admission to the weekly. 



334 LITERATURE AND INSTITUTIONS. 

As stated by Dr. Hunt/ " John C. Warren and X. Chabert 
were received with equal courtesy. In its department of 
reviews it was most complacent. From Rokitansky to Mrs, 
Joel Shew all were erudite. On its editorial pages nothing 
was attacked, everything was conciliated. Legitimate 
medicine was right to be sure, but the community would 
appreciate it better if it were not quite so right. Con- 
tributors of merit dropped off, and the journal became the 
recej)tacle of more ' remarkable cases' than any other was 
ever blessed with." From the date of this criticism there 
has been great improvement, and it is to-day one of the best. 
The first medical journal west of the Alleghanies was the 
"Western Quarterly Reporter of Medical, Surgical, and 
Natural Science," edited by John D. Godman, Cincinnati, 
1822-23, which reached number two of the second volume. 
This was followed by the " Ohio Medical Repository," 
edited by Guy W. Wright, issued semi-monthly, Cincinnati 
1826-2*7. This has become one of the rarest of American 
medical journals. The only articles of interest which it 
contains are a series of papers by Dr. John Locke, on the 
Medical Botany of the West, and a few reports of cases and 
contributions to pathological anatomy, by Dr. John P. 
Harrison. (This journal must not be confounded with 
another of the same name, published at the same place, in 
1835-36.) It was merged into the "Western Medical and 
Physical Journal," edited by Drs. Daniel Drake and Wright. 
At the end of the first volume, in 1S28, the editors agreed 
to disagree, and Dr. Wright published one number of a 
second volume, but the real continuation was issued by Dr. 
Drake, under the title of the " Western Journal of the 
Medical and Physical Sciences." Tliis contained some of 
Dr. Drake's best and most characteristic writings, and forms 
a valuable and interesting series. 

' Buffalo Medical Journal, 1856, xii. p. 312. 



LITERATURE AND INSTITUTIONS. 335 

Two attempts were made by Dr. Eberle to establish a 
journal at Cincinnati ; the first, the " Western Medical 
Gazette," after one or two suspensions, ceased with the 
second volume, in 1835 ; the second, the " Western Quar- 
terly Journal of Practical Medicine," 183T, did not get be- 
yond the first number. " The Western Lancet," edited by 
L. M. Lawson, continued from 1842 to 1857, when it took 
the name of " The Cincinnati Lancet and Observer," which 
is still flourishing. Several medical journals were started 
at Columbus, only one of which, " The Ohio Medical and 
Surgical Journal," 1848-64, was successful. A rare medical 
periodical and curiosity in its way is " The Belmont Medical 
Journal," published at Bridgeport, Ohio, under the auspices 
of the Belmont County Medical Society, 1858-60. With 
this belong the transactions of the same society from 1847 
to 1857, forming in all, three small volumes in 12mo. These 
publications are unique in their way, and illustrate what can 
be done by a county medical society, composed entirely of 
country practitioners. They contain some amusing flights 
of rhetoric, and some well-recorded cases, and many of the 
papers are interesting because it is evident that they were 
written precisely as the authors talked. 

The first medical journal of Kentucky was the " Transyl- 
vania Journal of Medicine," a quarterly, published at Lex- 
ington, from 1828 to 1839, forming a series of twelve 
volumes, of which complete sets are rare and valuable. 
In 1840 commenced "The Western Journal of Medicine 
and Surgery," Louisville, 1840-55, which may be consi- 
dered as a continuation of Dr. Drake's "Western Journal," 
above referred to, combined with the " Louisville Journal 
of Medicine and Surgery," edited by Drs. Yandell, Miller, 
and Bell, in 1838, and of which but two numbers were pub- 
lished. 

" The Richmond and Louisville Medical Journal," now 
in course of publication, edited by Dr. E. S. Gaillard, 1868- 



336 LITERATURE AND INSTITUTIONS. 

16, is a continuation of the " Riclimond Medical Journal," 
published at Richmond, Ya., 1866-68. "The American 
Practitioner," edited by Drs. D. W. Yandell and T. Parvin, 
1870-16, is a continuation of the " Cincinnati Journal of 
Medicine," commenced in Cincinnati in 1867. 

*' The Illinois Medical and Surgical Journal" commenced 
at Chicago in 1844, and has continued to the present time 
under various names, being now known as " The Chicago 
Medical Journal and Examiner." 

The first journal published west of the Mississippi was 
"The St. Louis Medical and Surgical Journal," founded 
by Dr. M. L. Linton, in 1843, which is still in existence. 

In the South the first medical periodical was the "Journal 
de la Societe Medicale de la Nouvelle Orleans," a quarterly, 
published in 1831. A monthly journal of the same name 
appeared in 1859-61. The most important is the "New 
Orleans Medical and Surgical Journal," which, with two 
suspensions, has continued from 1844 to the present time. 
" The Southern Medical and Surgical Journal," edited by 
Anthony Eve and others, published at Augusta, forms a 
series of twenty-one volumes, which contain many valuable 
cases, papers, and reports. " The Charleston Medical 
Journal and Review," 1846-60, and 1873-76, is the prin- 
cipal medical periodical of South Carolina. 

In Tennessee, " The Nashville Journal of Medicine and 
Surgery," 1851-61, and 1866-76, and "The Southern 
Journal of the Medical and Physical Sciences," 1853-57, 
are worthy of note. 

The principal medical journal in Virginia was "The 
Yirginia Medical and Surgical Journal," edited by G. A. 
Otis and others, Richmond, 1853-61. In the same city was 
published, during the war, "The Confederate States Medical 
and Surgical Journal," 1864-65, a quarto sheet containing 
much valuable data in military surgery. Complete files of 
this are very rare. 



LITERATURE AND INSTITUTIONS. 331 

On the Pacific coast eight medical journals, in all, have 
been commenced, two of which did not get beyond the first 
number. The oldest one now in existence is " The Pacific 
Medical and Surgical Journal," which began in 1858. 

Five medical journals have been commenced in Michigan, 
two of which are now in existence. 

Connecticut, Iowa, Maine, Minnesota, Xew Hampshire, 
New Jersey, Oregon, Vermont, and West Virginia have 
each had one journal, all of which are now extinct except 
"The West Virginia Medical Student." Perhaps two may 
be claimed from Maine, counting " The Journal of the 
Medical Society of Maine," one number of which was issued 
at Hallowell in 1834. 

Of journals devoted to dentistry there have been about 
twenty, making one hundred and thirty volumes in all. 

The earliest one was the "American Journal of Dental 
Science," which commenced in New York, in 1839, was 
suspended from 1860 to 1867, and is still in existence. 

In 1876 there are four dental journals in existence in this 
country, while England has but one, France two, and Ger- 
many one. 

Of journals devoted to pharmacy, there have been six 
worth mentioning; the oldest being the present "American 
Journal of Pharmacy," which began in 1825, as the "Jour- 
nal of the Philadelphia College of Pharmacy." This journal 
is by far the most valuable of this class in this country, and 
is furthermore noteworthy, and to be specially commended 
for having done what no medical journal in this country has 
accomplished, namely, the publishing of a complete index 
for its series, which was done in 1873, and which doubles 
the practical value of the set. The total number of volumes 
published of this class is ninety-four. 

Besides the regular encyclopedic medical journals, there 
have been about as many more devoted to "isms" and 
29 



338 LITERATURE AND INSTITUTIONS. 

" pathies," and to popular and family medicine and hygiene, 
many of these last being merely advertisements. 

With the recent development of specialties in medicine, 
several journals devoted to particular subjects have ap- 
peared, and an increase in the number of these may be 
expected. 

In this connection may be mentioned, as a curiosity in 
literature, a periodical publication devoted to the abuse of 
an individual physician, namely, the "Rush Light," pub- 
lished in New York in 1800, by William Cobbett, under the 
pseudonym of Peter Porcupine, for the vilification of Dr. 
Benjamin Rush. Seven numbers were issued, of which only 
the first two bore the imprint of place of publication, the 
last two were printed in Loudon, and a complete set is very 
rare. 

A most powerful agent for the diffusion in this country of 
the knowledge of the labours and writings of European 
physicians, has been the republication of the principal 
English Quarterly Reviews, of "Braithwaite's Retrospect," 
and of "Ranking's Abstract." To this should be added, 
perhaps, the so-called " American Edition of the London 
Lancet," which is a selection rather than a reprint, and the 
subscription list of which was at one time very large. 

Of journals printed in foreign languages, there have been 
commenced, three in German, three French, and one Spanish. 
The French journals were all issued at New Orleans : two 
of the German journals appeared in the State of New York, 
and one in Philadelphia. 

The Spanish journal was intended mainly for circulation 
in Cuba.^ Its issue ceased with the third number. 

Our medical journals vary so much in character, style, 
and purpose, that it is hardly possible to make any assertion 

• " Revista Medico-Quiiurgica y Dentistica." Quarterly. New 
York and Havana, 1S(38. 



LITERATURE AND INSTITUTIONS. 389 

with regard to the mass which shall be at the same time 
broad and true. They may be divided into three classes : 
first, those not connected with any medical school, and 
which draw their contributions from a wide field, including 
such as the "American Journal," "The New York Journal," 
"The Medical Record," "The Medical Times," and "The 
Boston Medical and Surgical Journal;" second, those which 
rely for contributions and material mainly on the professors 
of a medical school and the hospital clinics connected with 
it, but which are not specially devoted to its interests; third, 
those which are mainly devoted to advocating the interests 
of a school, and the attacking rival institutions, and which 
are, to use Carlyle's phrase, "Windmills put out to catch 
or take advantage of the wind of popular favour." These 
journals sometimes contain valuable reports of cases obtained 
from the college clinics, but the personal editorial element 
in them is usually in excess, and they are of interest to but 
a small local circle. To them applies the untranslatable 
French criticism, " II y a trop de tintamarre la dedans, 
trop de brouillamini." 

Of the first class, some compare favourably with the best 
of the journals of other countries: of the last class, some 
are as bad as, but not worse than, the worst. Compara- 
tively few persons are acquainted with the poorer class of 
foreign medical journals, published in the smaller towns of 
the provinces, which have most of the defects which are so 
strongly condemned in some of our own publications as if 
they were unique. 

The reports to the American Medical Association, by its 
committees on American Medical Literature, devote much 
space to periodicals, and contain many judicious criticisms 
upon their defects and errors. A common complaint is that 
there are too many. The reply to this is usually that of 
Dr. Drake, that it is desirable that the country practitioners 
be induced to write, and that one means of doing this is 



340 LITERATURE AND INSTITUTIONS. 

the diffused localization of journals. This is due to the fact 
that inexperienced and modest men will furnish an article 
or report to a journal in their immediate neijxhbourhood, 
with whose editor they are personally acquainted, while they 
would not do so to one at a distance. 

The number of subscribers to the greater number of our 
journals is small, the issue being, for many, less than a 
thousand, and, for some, hardly five hundred copies. 

The motive for the existence of the minor journals is not 
for direct profit, but as an indirect advertisement for certain 
individuals, or — and this is more common — the desire to 
have a place in which the editor can speak his mind and 
attack his adversaries without restraint. The defects in the 
medical journals are, to a certain extent, the characteristic 
ones in our medical literature, and are chargeable mainly to 
the lack of general education and mental culture in the 
majority of readers whose tastes are to be accommodated. 
An urgent want of many of the subscribers is a sort of con- 
tinuation of the course of education given in the schools. 
We find, for instance, in the pages of some medical journals, 
articles which make no pretensions to oi'iginality, but are 
simply didactic lectures to a class in absentia. The defects 
in the so-called original contributions are, for the most part, 
due to imperfect education in the writers, and betray, not 
merely an ignorance of facts previously ascertained and re- 
corded, but defective mental training and an inal)ility to 
comprehend the relations of the facts which are known, the 
result of which is the stringing out of a series of irrelevant 
and tedious details, and, in the attempts at deduction, the 
production either of vague and valueless generalizations, or 
conclusions which do not follow from the premises. As 
an illustration, take the majority of the articles which have 
appeared on a disease which would seem to be peculiar to 
this country, viz. the so-called "milk-sickness" or "trembles." 

Since the first notice on this affection in Dr. Drake's 



LITERATURE AND INSTITUTIONS 341 

Notices of Cincinnati, in 1809, there have been printed four 
pamphlets and one hundred and ten (110) articles in journals 
and transactions, on this subject. Yet it cannot be said to- 
day, that we have any definite knowledge as to the pathology 
or causes of this afiection, or that, so far as man is con- 
cerned, we are absolutely certain that there is any special 
disease which should be thus named, as being caused by the 
milk, or flesh of cattle affected with the "trembles." It 
has been said to be caused by certain plants, yet no scientific 
experiments have been made on the effects of these plants. 
No attempt has been made to produce the disease in an 
animal remote from infested localities, by the use of the sus- 
pected plants, or better, by the use of an extract containing 
their active principles ; no chemical or microscopical exami- 
nations have been made, in short, w^e have nothing but an 
account of symptoms, and much of that is from hearsay. 

Many articles intended to be practical, are very far from 
being such, although the authors would probably be surprised 
and indignant to hear them termed otherwise. They profess 
to give the results of the writer's personal experience with 
a certain disease, but this disease is only named, not 
described, and the gross results only are given, that is to 
say, we are told how many recovered. The object of such 
writers, to use their own words, is to tell us "what is good 
for biliousness, or low fever, or pneumonia." Their pro- 
ductions read curiously, like the literature of the last century, 
and are to be classed with old women's advice ; amusing 
generally ; practically suggestive sometimes ; clear, scien- 
tific, and conclusive, never. 

The so-called clinical lectures, and reports of cases and 
operations, are of two kinds. When properly prepared 
they are most useful and valuable, and are the best con- 
tributions to a journal which the majority of physicians can 
make, although by no means the highest class of medical 
literature. But a large number of such articles as are pub- 

29=^ 



342 LITERATURE AND INSTITUTIONS. 

lislied, are simply padding, worse than useless, since their 
titles become a part of the bibliography of medicine, com- 
pelling each succeeding inquirer to refer to them, or risk 
the loss of some really valuable reference. 

We have reached that stage of development, when it is 
in no way desirable that we should be informed that one 
dislocated shoulder was reduced, one leg amputated, and 
two hare-lips operated upon, not even if the usual text-book 
explanations are added, so as to make up the five or six 
pages of the report of a college clinic. We have had 
enough reports of specimens of "Aneurism of the Aorta," 
or "Medullary Sarcoma," or "Tumour of the Breast," in 
which little or no information is given with regard to the 
symptoms during life, and the principal fact stated is the 
size or weight of the specimen. 

It is a useless case of labour which lingers through three 
or four pages, to terminate in the usual manner with the 
stale old moral about " meddlesome midwifery," and it is 
at once amusing, exasperating and pathetic, to glance over 
the "contributions from the clinic" of the young specialist 
who has set to work to write himself into notice, not in a 
journal devoted to his specialty, but in one of the encyclo- 
pedic periodicals, having been instructed that this is " legiti- 
mate advertising." 

"Medical journalism is not a profession in this country. 
With one or two exceptions, our medical editors are engaged 
in practice and lecturing, and their labour in connection 
with the journals is not directly remunerative, nor is it the 
main object of their thoughts." The result of this appears 
in that large section of almost every journal which is devoted 
to reviews, abstracts, news items, etc. Nevertheless, as we 
have before stated, our medical journals are the most im- 
portant and valuable part of our medical literature, and it 
is mainly in and by them that improvement may be hoped 
for and effected. 



LITERATURE AND INSTITUTIONS. 343 

At the beginniiifr of 18TG, there were in course of publica- 
tion thronirliout the world about 280 regular raedical jour- 
nals. Of this number, Germany and Austria had 57 ; France 
52; Great Britain, not including her Colonies 29; the 
United States 4G; Italy 31 ; Belgium 8; Mexico 8; Cannda 
T ; Holland 6 ; Spain G. As to the form of publication, the 
United States has the largest proportion of monthlies, and 
France and Germany of weeklies and bi-weeklies. 

The proportion of periodical to other forms of medical 
literature is in excess in this country, as will be clearly seen 
if we compare the uumber of medical books published in 
the several countries. Taking the "Bibliotheca Medico- 
Chirurgica," of Ruprecht, for the years 1874-75, and 
counting the publications noted in it, excluding journals, 
pamphlets, and popular and irregular works, we find that 
the United States is credited with 55 volumes ; England 
179; France 409; Germany 419; Italy 120; Spain and 
Portugal 104. If we count only first editions of original 
works, we find that the United States has published during 
these two years 3G ; England 92; France 314; Germany 
288 ; Italy 88 ; and Spain and Portugal 30. 

These figures are, of course, not exact, but the propor- 
tions shown are probably nearly correct. Taking the 
number of volumes of medical publications of all nations, 
excluding journals, for these two years, the United States 
has published about six per cent, of the whole, certainly 
not the quantity which should have been produced if every- 
thing was as it should be. 

Medical Societies. — An important influence upon the 
progress of medicine, and the relations of physicians to each 
other, and to the public, has been exerted by our medical 
societies, some of which date from the last century, and 
which are found almost everywhere. The first State 
medical societies, such as those of New Jersey, Massachu- 
setts, Delaware, New York, etc., were charged with the duty 



344 



ITERATURE AND INSTITUTIONS. 



of licensing persons to practise medicine, to which license 
an examination was a necessary preliminary. In this way 
these societies were the principal agents in fixing the 
standard of medical education, and although after the estab- 
lishment of medical schools the diploma of one in good 
repute was accepted in lieu of an examination, this was by 
courtesy rather than law, and made it necessary that the 
standard of the schools should at least be equal to that 
prescribed by the society. For convenience of reference, 
we give a list of the most important medical societies of the 
United States, arranged in alphabetical order by States : — 



Araerican Medical Association 
Ameiican Oplithalmological Society 
American Otological Society 
American Pharmaceutical Association 
American Public Health Association 
National Quarantine and Sanitary Con 

veutiou ..... 
Medical Association of the State of Ala 

bama ..... 

State Medical Association of Arkansas , 
Medical Society of the State of California 
Territorial Medical Society of Colorado 
Connecticut State Medical Society 
Medical Society of Delawnre 
Medical Society of the District of Co 

lumbia ..... 
Clinico-Pathological Society of Wash 

ington ..... 
Florida Medical Association . 
Georgia Medical Association 
Georgia Medical Society of Savannali 
Illinois State Medical Society 
Drake Academy of Medicine 
Indiana State Medical Society 
Iowa State Medical Society . 
Medical Society of the State of Kansas 
McDowell Medical Society 
Kentucky State Medical Society . 
Societe Medicale de la Nouvelle Orleans 
Medical Society of the State of Maine 
Maine Medical Association . 



Organ- 
ized. 

1847 

1864 
1868 
1852 

1872 

1857 

1847 
1870 
1870 
1871 

1792 
1789 

1833 

1865 
1874 
1849 
1804 
1851 
1872 
1849 
1850 
1858 
1874 
1851 
1812 
1834 
1853 



First No. of vols 
pubilca- of publica- 
tion, tions. 



1848 
1865 
1869 
1852 
1875 

1857 

1848 
1871 
1870 
1872 
1844 



1874 



1875 
1850 



1851 

1874 
1849 
1850 
1867 
1875 
1851 
1831 
1834 
1853 



27 
7 
1 

24 
1 



19 
5 
5 
5 

20 



1 

20 

23 
1 

27 
10 
2 
1 
19 
3 
1 
6 



LITERATURE AND INSTITUTIONS. 



345 



Medical and Chirurgioal Faculty of 
Maiylaiid ...... 

Boston Society for Medical Iinprovenient 
Boston Society for Medical Observation 

Boylston Medical Society 

Gynaecological Society of Boston . 
Massachusetts Medical Society 
Michigan State Medical Society 
Minnesota State Medical Society . 
Medical Association of the State of Mis 

sissippi ..... 
M(-dical Society of the State of Missouri 
Nebraska State Medical Society . 
New Hampshire Medical Society . 
New Jersey State Medical Society 
Medical Association of Southern Central 

New York .... 

Medical Society of the County of Albany 
Medical Society of the County of Kings 
Medical Society of the County of New 

York ..... 

Medical Society of the State of New York 
Medico-Legal Societ^y of New Yoik 
New York Academy of Medicine . 
New York Medical Journal Association 
Pathological Society of New York 
Physico-Medical Society of New York 
Medical Society of the State of North 

Carolina ..... 
Academy of Medicine of Cincinnati 
General Medical Society of Ohio . 
Medical Convention of Ohio . 
Ohio State Medical Society . 
Belmont Medical Society 
Medical Society of the State of Oregron 
College of Pliysicians of Philadelphia 
Medical Society of the State of Penn 

sylvania ..... 
Pathological Society of Phi lad el phi a 
Philadelphia County Medical Society 
Philadelphia Obstetrical Society . 
Rhode Island Medical Society 
Medical Society of South Carolina 
South Carolina Medical Association 
Tennessee State Medical Society . 
Medical Association State of Texas 



Organ- 
ized. 

17S9 
1828 



First No. of vols 
publica- ofiml'lica- 
tion. tiuns. 



1853 
1853 



( 


70 prize essays 


isnl 


publi 


shed iu 


1 


iournals. 


1869 


1869 


5 


1781 


1790 


41 


1819 


1850 


15 


1855 


1870 


6 


1856 


1870 


1 


1850 


1850 


12 


1868 


1869 


6 


1791 


1854 


21 


1766 


1859 


17 


1847 


1848 


11 


1806 


1864 


2 


1822 


1858 


2 


1806 






1807 


1808 


34 


1867 


1874 


1 


1847 


1851 


8 


1864 




... 


1844 




... 


1815 


1817 


1 


1850 


1850 


22 


]857 




... 


1827 


1829 


2 


1835 


1835 


13 


1846 


1850 


26 


1847 


1818 


8 


1874 






1787 


17 93 


11 


1848 


1851 


18 


1857 


1869 


4 


1849 





... 


1868 


1873 


3 


1812 


1859 


1 


1789 




... 


1848 


1849 


16 


1830 




... 



1869 



1869 



Organ- 
ized. 


First 

pnljlica- 

tion. 


No. of vols, 
of publica- 
tions. 


1814 
1821 
1873 


18G4 
1871 
1873 


4 
5 
3 


1867 
1842 


1808 
1856 


8 
9 



346 LITERATURE AND INSTITUTIONS. 



Medical Society of the State of Vermont 1814 
Medical Society of Virjjfiuia . 
Medical Society of Wasliiiigton Territory 
Medical Society of the State of West 
Virginia ...... 

Wi.scoiisin State Medical Society . 

The formation of the American Medical Association was 
due to a wide spread and loudly expressed dissatisfaction 
on the part of the leading physicians of the country, with 
the low standard of medical education, and to a general 
conviction that the remedy for this lay neither with the 
schools nor the State medical societies. It was hoped that 
by forming an association whiclf should represent all parties 
interested, a sufficient pressure of opinion might be brought 
to bear upon '^physicians and upon the schools, to secure the 
return to the requirements for graduation of the earlier 
medical colleges. After one or two futile attempts, the 'New 
York State Medical Society set on foot a movement which 
resulted in a meeting of a convention in the city of New 
York, in the year 1847, in which were present representa- 
tives of medical societies and colleges from sixteen States. 
A similar convention met the following year in Philadelphia, 
at which the title, by which it is now known, was assumed. 
The series of its annual volumes of transactions contains 
some reports and papers of much value and interest, mingled 
with much that is unworthy of publication under the auspices 
of our National Medical Society, or indeed of any other. 
Many of the reports of the chairmen of the several commit- 
tees are of permanent historical value. Its most valuable 
contribution to our literature, has been the publication of a 
code of ethics, which is, theoretically at least, accepted as 
authoritative throughout the United States, and which, 
although some of its provisions have been objected to, is, as 
a whole, the most satisfactory exposition in existence of the 



LITERATURE AND INSTITUTIONS. 347 

proper relations of physicians to each other, and to the 
public. 

Of late years, the original purpose of this association has 
been to some extent departed from. 

It was not primarily intended to promote literature or 
scientific research, or to afford a means of publication for 
writers. Our national and State medical societies have 
been mainly useful as social gatherings, promoting acquaint- 
ance, and the feeling of professional brotherhood and esprit 
de corps among their numbers, and as giving the means for 
agreement, and the expression of opinion, upon questions 
relating to education, ethics, etc. ; by that large body of 
physicians engaged in general practice, who do not write or 
lecture, but simply vote. As sources of addition to the 
science and literature of medicine, they do not play a con- 
spicuous part, nor is it easy to see how it can be otherwise; 
the real discovery, the carefully prepared paper, the descrip- 
tion of a new symptom, pathological appearance or remedy 
are not usually communicated to such societies. No effectual 
supervision as to quality of papers which may be read or 
printed can, or at least will be exercised by committees, and 
a communication which a first class medical journal has 
'^declined with thanks," may be taken to the State, and 
even to the National Society with a reasonable certainty 
that it can be made to appear in the transactions. The dis- 
cussions on papers in such associations seldom have any 
scientific value, from want of special preparation on the part 
of the speakers, although they are sometimes amusing, and, 
to use an expressive word, "spicy," from the use of 
personalities. Whether this state of things can be improved 
is doubtful, though attempts to do so are of course commen- 
dable.^ 

^ The best suggestion to this end for the Ameiic.n Medical As- 
sociation which 1 liave heard is that each section should elect its 
own officers aud members, and should be managed by a special 



348 LITERATURE AND INSTITUTIONS. 

The journals have to a great extent superseded tlie neces- 
sity of using societies as a means of publication, and the best 
work of such associations seems to consist in bringing the 
leaders into personal relation with the mass of the^profes- 
sion, and in serving as courts of arbitration and appeal, 
where local difficulties can be adjusted, and whose decisions 
will command the assent of the majority of their members. 

The Transactions of the New York State Medical Society 
were, for a number of years, published by the State, which 
proved, upon the whole, to be not a desirable mode of issue, 
and the last volume, published by the society itself, is a 
great improvement upon its predecessors. What such 
societies might do is shown by the paper of Dr. Thomas C. 
Brinsmade, giving an accurate record of his practice for 
twenty-one years. This makes 300 pages of the volume of 
the Transactions of the New York State Medical Society 
for 1858, and contains carefully analyzed statistics of 37,872 
cases. This had been preceded in 1851 by an elaborate 
account of the medical topography of the city of Troy, his 
place oji residence. Taken together, these papers are very 
valuable, and set an example of a mode of adding to the 
store of medical knowledge, which is within the power of 
every practitioner. 

An interesting experiment is now in course of trial in 
Alabama, where the State Medical Society has been made 

committee who shall designate the subject for discussion, and the 
leaders in debate. If the members of the committee eacli year are 
selected from a single city, it would have an additional advantage. 
For instance, let the managing committee of the surgical section 
be, this year, all residents in New York city, while Boston takes 
obstetrics, Philadflphia practice, etc. The next j'ear New York 
can take practice, Chicago surgery, etc. In other words, transfer 
all the responsibility for scientific work to the sections, and let 
these sections be organized and managed systematically to that 
end alone. 



LITERATURE AND INSTITUTIONS. 349 

the State Board of Health, and the official adviser of the 
Legislature in all matters })ertaining to public hygiene. 

The American Public Health Association, organized in 
1872, may now be considered as fairly established. The 
operations of this society have special interest to the medical 
profession, since it may become an important means of edu- 
cating the public, and enabling it to distinguish between the 
scientific physician and the ignorant pretender. 

We have another class of medical societies which require 
an abundance of clinical and pathological material ; members 
actually engaged in original investigations, and frequent 
raeetings, as conditions for usefulness and success. As a 
rule, these can only exist in large cities, where they exert a 
powerful influence and stimulus to exertion on their indi- 
vidual members. It must be admitted that our societies of 
this kind seldom bring out the best work of their members, 
and that such discussions as occur in similar societies in 
London and Paris, continued week after week, and even 
month after month, for which elaborate preparation is made 
by the speakers, and in which the results of clinical obser- 
vation and extensive literary research are rendered attractive 
and striking, by splendor of diction and perfection of style, 
are very rare. 

The most important of these societies are the College of 
Physicians of Philadelphia, the New York Academy of 
Medicine, the pathological societies of Philadelphia and 
New York, the Boston Society for Medical Improvement, 
and certain societies devoted mainly to specialties. Among 
these should be mentioned the Medico-Legal Society of New 
York, organized in 1867. In 1874 it published a volume of 
papers relating to medical jurisprudence, which will be fol- 
lowed by others. It is also forming a valuable library in its 
own department, and has been the means of bringing the 
members of the medical and legal professions of New York 
to better acquaintance with each other. It is but justice to 
30 



350 LITERATURE AND INSTITUTIONS. 

say that much of its good work and prosperity is due to the 
energy of its late president, a prominent lawyer, Mr. Clark 
Bell. 

The majority of our physicians are, and must be, content 
to leave to a few special workers the labour and pleasure of 
sifting and selecting from the original sources of medical 
literature, having neither the wish nor the power to examine 
for themselves the works of the great leaders and teachers 
of times past, or the mass of books and pamphlets which 
are daily streaming from the press ; but there is neverthe- 
less among them a fair amount of appreciation of the value 
and necessity of such work, and of the usefulness and desira- 
bility of collections of the records of their science. During 
the last ten years, the writer has had occasion to examine 
many private libraries of physicians in all parts of the 
country, in country villages as well as the large cities, and 
it has been a matter of surprise and pleasure to find so much 
interest taken in subjects relating to the history and biblio- 
graphy of medicine by men remote from large libraries, and 
without the stimulus of companionship in, and sympathy 
with such tastes. And it will usually be found that the 
physician who has on his shelves half a dozen old folios and 
quartos, including perhaps copies of Sydenham, Morgagni, 
and Yan Swieten, is a man of more culture and broader 
views than the one who has only the modern manuals, or 
rather those which were modern when he attended lectures. 

Until recently few of our writers have made much use of 
bibliographical research. We now have public medical 
libraries in this country, which afford to the student and 
scholar good facilities for research, and which bid fair, at 
no distant day, to rival in magnitude and practical working 
value, if not in manuscripts and incunabulae, the best in the 
old world. 

Philadelphia has several libraries of much interest and 
value to the medical bibliographer and scholar. The oldest 



LITERATURE AND INSTITUTIONS, 851 

medical library in this countr}' is that of the Pennsylvania 
Hospital, founded in 1762, and now containing about 13,000 
volumes, many of which were selected for the hospital by 
Doctors Lettsom, in London, and Louis, in Paris. Its 
classed catalogue, issued in 1857, is a valuable work of 
reference. 

The library of the College of Physicians, of Philadelphia, 
which dates from 1788, now contains about 19,000 volumes 
well selected, receives about eighty current journals, and, 
next to the library at Washington, is the most valuable col- 
lection of the kind in this country. Much of its prosperity 
and excellence is due to Doctor Samuel Lewis, whose dona- 
tions, amounting to several thousand volumes of choice 
books, are kept in a room by themselves, and known as the 
" Lewis Library," The great want of this library is a good 
printed catalogue, which would double its value and useful- 
ness. The medical part of the Loganian Section in the 
Philadelphia Library contains about 1800 volumes, mostly 
old and rare. These three libraries supplement each other 
to a great extent, there being probably not less than 26,000 
volumes between them, which are not duplicates. The fourth 
library is at the University of Pennsylvania, in West Phila- 
delphia, and contains about 3000 volumes, the gift of Dr. 
Alfred Stille. It may be noted here that almos.t all attempts 
to establish medical libraries in connection with medical 
schools have been failures. Commenced with enthusiasm, 
they soon become antiquated, are rarely consulted, except 
by one or two species of beetles, are never properly cata- 
logued or cared for, and dust and mould reign in them 
supreme. Students and teachers want the newest books 
and journals only. Libraries are used by the scholar and 
author, and for such are the true universities. 

In New York, the library of the New York Hospital is 
the largest of its class, containing about 10,000 volumes. 
An excellent foundation for a library has been acquired by 



352 LITERATURE AND INSTITUTIONS. 

the Academy of Medicine, by the gift from Dr. Purple of a 
complete file of regular American medical journals and of a 
large number of rare pamphlets. The collections of journals 
of the Medical Journal Association of New York, and the 
German Dispensary are valuable sources of information to 
the student. 

The Boston Public Library has at present the best collec- 
tion of medical books in that city, numbering about 11,000 
volumes, for the most part standard works and periodicals. 
Its usefulness is much diminished from the want of a good 
printed catalogue of this section. The library of Harvard 
College contains between 5000 and GOOO volumes on medi- 
cine ; and the Treadwell Library, at the Massachusetts 
General Hospital, has about 5000 volumes. The medical 
library of most promise in Boston is that of the Medical 
Library Association, which, though only a year old, has 
about 3000 volumes, and will probably rapidly increase. 

In Cincinnati the City Hospital lias a fair collection. The 
Mussey Medical and Scientific Library, at present, is a 
special deposit in the Cincinnati public library, and con- 
tains about 4000 volumes and 2000 pamphlets. 

The National Medical Library at Washington, under the 
direction of the Surgeon-General of the Array, contains 
40,000 volumes, and about the same number of pamphlets. 
It has been formed within the last twelve years, and the use 
that is made of it by physicians from all parts of the country, 
and the general and strong interest that is felt in its pro- 
gress affords satisfactory evidence, if such were needed, that 
it meets a want of the profession. Its subject catalogue is 
nearly ready for the press. 

Besides these public libraries, there are several valuable 
private collections of medical works in this country, some 
of which have been already given to public use, such as 
those of Drs. Purple, Stille, and Mussey, already referred 
to. Two others are worthy of special mention, the first 



LITERATURE AND INSTITUTIONS. 353 

being that of Dr. G. J. Fisher, of Sing Sing, which is rich 
in the classics of medicine ; and the second, that of Dr. J. 
M. Toner, of Washington, which is especially devoted to 
American medical literature, and contains many rare pam- 
phlets, besides a nearly complete file of American medical 
journals. In connection with this last, there is nearly ready 
for the press a complete index. Besides these, there are a 
number of valuable private medical libraries in this country, 
ranging from 1000 to 8000 volumes, and the number of 
foreign works imported, and the taste for original editions 
is steadily increasing. It is now possible to verify in this 
country the majority of the references made by European 
medical authors, and it is no longer necessary to make costly 
importations, or to visit Europe to obtain literary data. 

With the libraries should be classed the medical museums, 
of which several of much interest and importance have been 
formed in the United States, for the most part in connection 
with medical societies and hospitals. The catalogues of 
these collections, when properly prepared, are very useful 
books of reference, and some excellent work of this kind has 
been accomplished, such as the Catalogues of the Warren 
Anatomical Museum of Harvard, and of the Museum of 
the Boston Society for Medical Improvement, each by Dr. 
J. B. S. Jackson ; of the Pathological Museum of the Penn- 
sylvania Hospital, by Dr. Wm. Pepper; of the Pathological 
Cabinet of the New York Hospital, by Dr. Ray; and of the 
Army Medical Museum at Washington, by Drs. Woodhull, 
Curtis, and Woodward. 

The College of Physicians of Philadelphia has a valuable 
collection, including the Mtitter Museum, and a series of 
unique preparations by HyrtL 

The practical value of large special museums in connec- 
tion with good libraries devoted to the same specialities is 
great, but they are useful rather to the educated physician 
than to the student; and the numerous small collections 

30* 



354 LITERATURE AND INSTITUTIONS. 

which are sccattered over tlie country, in hospitals and 
private cabinets, are simply so much wasted and unused 
material, in a scientific point of view, and, though gratifying 
to the owner as trophies or mementoes, are of little more 
real use than the strings of teeth which the barbers of old 
hung out as signs of their skill. 

The value of a single specimen of any lesion is usually 
very small ; it is only when they can be brought together 
by scores and compared that useful and reliable results can 
be hoped for. As we get older and wiser, we shall proba- 
bly have fewer journals, medical schools, museums, and 
libraries than we now possess, for all these means of culture, 
to have the best effect, require concentration. 

Although the permanent importance of oral teaching has, 
to some extent, been diminished by the diffusion of peiiodical 
literature, since the latest discovery or theory can now be 
promptly made known to those remote from the great centres 
of learning, the increased use made of clinical instruction, 
and the necessity for practical demonstration^of instrumental 
methods of diagnosis, have in a great degree compensated 
for this. 

The medical history of a country cannot be considered 
comj)lete without some account of its medical schools, but 
we have space for little more than a list of those which have 
flourished in the United States. 

The following table gives a list of the regular chartered 
medical schools of this country, which have had the power 
of conferring the degree of doctor of medicine, with the 
date of first graduating class, date of cessation, and number 
of graduates to the spring of 1876, so far as it has been 
possible to obtain the data: — 

It is possible that a few minor schools of short duration 
have been overlooked, but such must have been of small 
importance. No note is made in the list of the various 
changes of name which some of the schools have assumed. 



LITERATURE AND INSTITUTIONS. 



355 



The number of graduates lias been obtained by collation of 
all the catalogues that could be obtained, and by correspon- 
dence. From these data an estimate has been made for the 
missing years, and the limit of error in the total does not 
probably exceed one-half of one per cent. It should be 
observed that little reliance can be placed upon many of the 
catalogues as to the number of students in attendance, and 
there are some discrepancies even as to graduates. 



Alabama. 
Medical College of Alabama [Mobile] . 

California. 

Medical College of the Pacific, Med. 

Dept. of University (City) College 

[San Francisco] .... 

University of California, Med. Dept. of 

(Toland Hc\ll) [Sau Francisco] . 

Connecticut. 
Yale College, Med. Dept. of [New Haven] 

District of Columbia. 

National Medical College, Med. Dept. of 

Columbian University [Washington] 

Georgetown University, Med. Dept. of 

[Washington] . . . . . 

Howard University, Med. Dept, of 

[Washington] ..... 

Georgia. 
Medical College of Georgia [Augusta] . 
Savannah Medical College [Savannah] 
Atlanta Medical College [Atlanta] 
Oglethorpe Medical College [Savannah] 

Illinois. 

Rush Medical College, Med. Dept. of 
University of Chicago [Chicago] 

Illinois College, Med. Dept. of [Jack- 
sonville] ...... 

Rock Island Medical School [Rock Is- 
land] 

Chicago Medical College, Med. Dept. of 
Northwestern University [Chicago] . 



Tear of 
first gra- 
duation. 


Date of 
cessation. 


Total No. 
of gra- 
duates. 


18G0 




203 


1859 




90 


1865 





86 


1814 




899 


1826/ 




427 


1852 





387 


1871 





37 


1833 
1854 
1855 
1856 


1861 


1278 
140 
560 

86 


1844 





1786 


1848 


1848 


39 


1849 


1849 


19 


1860 




481 



356 LITERATURE AND INSTITUTIONS. 



Name. 

Indiana, 

Indiana Medical College, Med. Depart, 
of Laporte University [Laporte] 

Medical College of Evausville [Evans- 
ville] 

Indiana Central Medical College [In- 
dianapolis] ..... 

Indiana Medical College [Indianapolis] 

Indiana College of Physicians and Sur- 
geons [Indianapolis] 

Iowa. 

College of Physicians and Surgeons 

[Keokuk] . • . . . 

Iowa State University, Med. Dept. of 

[Iowa City] 

Kentucky. 

Transylvania University, Med. Dept. of 
[Lexington] 

University of Louisville, Med. Dept. of 
[Louisville] ..... 

Kentucky School of Medicine [Louis- 
ville] 

Louisville Medical College [Louisville] 

Hospital College of Medicine, Med. Dept. 
of Central University [Louisville] 

Louisiana. 
University of Louisiana, Med. Dept. of 

[New Orleans] ..... 
New Orleans School of Medicine [New 

Orleans] ...... 

Charity Hospital Medical College of New 

Orleans [New Orleans] 

Maine. 

Bowdoin College and Med. School of 

Maine [Brunswick] .... 

Alari/hmd. 

University of Maryland, Med. Dept. of 
[Baltimore] ..... 

Washington University, School of Medi- 
cine [Haltiniore] .... 

College of Physicians and Surgeons 
[Baltimore] ..... 



Year of 
first gra- 
duation. 


Date of 
cessation. 


Total No. 
of gra- 
duates. 


1842 


1851 


136 


1850 




74 


1850 
1870 


1852 


39 
251 


1875 






1850 




777 


1871 




111 


1818 


1859 


1860 


1838 




2395 


1851 
1870 





520 
402 


1875 




91 


1835 




1703 


1857 


1870 


397 


1876 




10 


1821 





1137 


1811 

1828'^ 





3104 





680 


1873 




118 



LITERATURE AND INSTITUTIONS. 357 





Year of 




Total No. 


Name. 


first gra- 


Date of 


of gra- 




duation. 


cerisation. 


duates. 


Massachusetts. 









Harvard University, Med. Dept. of [Bos- 
ton] 1785 2206 

Berkshire Medical College, [Pittsfield] 1823 18G7 113G 

Michigan. 

University of Michigan, Med. Dept. of 

[Ann Arbor] 1851 1405 

Detroit Medical College [Detroit] . 1869 204 

Missouri. 

Missouri Medical Collece [St. Louis] . 1841 921 

St. Louis Medical College [St. Louis] . 1843 1293 

Humboldt Medical College [St. Louis] . 1867 1869 16 
Kansas Citj College of Physicians and 

Surgeons . . . . • .1870 46 

St. Louis Colleere of Physicians and Sur- 
geons [St. L^ouis] .... 1870 1870 8 

Neio Havipshire. 

Dartmouth College, Medical School of 

[Hanover] 1798 1283 

New York. 

College of Physicians and Surgeons of 

the City of New York, Med. Dept. of 

Columbia College [N. Y. City] . . 1769 3179 

College of Physicians and Surgeons of 

the Western District of New York 

[Fairfield] 1816 1840 585 

Geneva College (Rutgers Med. Faculty) / 

[N. Y. City] 1827 ' 1830 104 

Geneva Medical College [Geneva] . 1835 1872 849 

Albany Medical College [Albany] . 1839 1287 

University of the Citv of New York, 

Medical Dept. of [N.' Y. City] . . 1842 3393 

University of Bnflfalo, Med. Dept. of 

[Buffalo] 1847 848 

Kew York Medical College and Charity 

Hospital [N. Y. City] . . . 1851 1864 310 

Long Island College Hospital [Brooklyn] 1860 531 

Bellevue Hospital Medical College [N. 

Y. City] 1862 1908 

College of Medicine of Syracuse Uni- 
versity [Syracuse] . ' . . . 1873 26 



358 LITERATURE AND INSTITUTIONS. 

Year of Total No. 
Name. first gra- Date of of gra- 
duation, cessation. duates. 
Ohio. 

Medical College of Ohio [Cincinnati] . 1821 2170 

Cincinnati College, Med. Dept. of [Cin- 
cinnati] 1836 1839 95 

Starling Medical College [Columbus] . 183G 887 

Cleveland Medical College, Med. Dept. 
of We.stern Reserve College at Hud- 
son [Cleveland] .... 1844 1162 

Cincinnati College of Med. and Surgery 

[Cincinnati] 1852 760 

Miami Medical College [Cincinnati] . 1853 578 

University of Wooster, Med. Dept. of 

[Cleveland] 1865 -328 

Oregon. 

Willamette University, Med. Dept. of 

[Salem] 1867 63 

Pennsylvania i 

University of Penn.sjlvania, Med. Dept. 

of [Philadelphia] .... 1768 8845 

College of Philadelphia [Philadelphia] 1790 1791 10 

Jefferson Medical College [Philadelphia] 1826v 6G68 

Penn.sylvania College at Gettysburg, 

Med. Dept. of [Philadelphia] . . 1840 1861 769 

Franklin Med. College of Philadelphia 

[Philadelphia] 1847 1849' 25 

Philadelphia College of Medicine [Phila- 
delphia] . ... . . .. 1847 1859 502 

Rhode Island. 

Brown University, Medical School of 

[Providence] 1814 1826 68 

South Carolina. 

Medical School of the State of South- 
Carolina [Charleston] . . . 1825 2439 

University of South Carolina, Med. Dept. 

of [Columbia] 1888 26 



Ti 



ennessee. 



Memphis Medical College [Memphis] . 1847 1873 231 
University of Nashville, Med. Dept. of 

[Nashville] 1852 1741 

Shelby Medical College [Nashville] . 1859 1861 30 
Vanderbilt University, Med. Dept of 

[Nashville] 1875 75 



LITERATURE AND INSTITUTIONS. 3o9 

Year of Total No. 

Name. first gra- Date of of gra- 

duation, cesbation. duates. 

Galveston Medical College [Galveston] 1866 123 

Texas Medical College and Hospital 

[Galveston] 1874 38 

Vermont. 

Castleton Medical College [Castleton] . 1820 1861 1449 

University of Vermont and State Agri- 
cultural College, Med. Dept. of [Bur- 
lington] 1823 573 

Vermont Medical College [Woodstock] 1830 . 1860 575 

Virginia. 

University of Virginia, Med. Dept. of 

[Charlottesville] .... 182g 533 

MedicalCollegeof Virginia [Richmond] 1839 947 

Winchester Medical College [Winches- 
ter] 1846 1862 75 

Total 73,588 

If we take the number of graduates by decades of years 
during the present century, the result is as follows : — 

Years. No. of graduates. Years. No. of graduates 

1769-1799 . . 221 1840-1849 . . 11.828 

1800-1809 . . 343 1850-1859 . . 17,213 

1810-1819 . . 1,375 18C)0-1869 . . 16,717 

1820-1829 . . 4,338 1870-1876 . . 14,704 

1830-1839 . . 6,849 

The first medical school in this country was established 
by Drs. John Morgan and William Shippen at Philadelphia 
in 1765, and is now known as the Medical Department 
of the University of Pennsylvania. From its halls have 
graduated the majority of the distinguished medical writers, 
teachers, and practitioners of the United States, and the 
names of its professors have become household words. 

Organized upon the plan of the Edinburgh Medical 
School, of which its founders were graduates, it has been 
the model and pattern by which all our medical colleges 
have been shaped. Its largest graduating class was in 1849, 
numbering 191. In the following year Professor Chapman 



360 LITERATURE AND INSTITUTIONS. 

resigned, and for the next ten years the Jefferson School 
graduated the greater number, reaching its maximum of 269 
in 1854. The Jefferson Medical College was founded in 
1824, under the charter of Jefferson College in Canonsburg, 
Pennsylvania. The first course of lectures was delivered in 
1825-26, the Faculty being Drs. Eberle, McClellan, Rhees, 
Green, and Beattie. Numerous changes were made in pro- 
fessors, and its classes varied much in size until 1841, when 
all the chairs were vacated and refilled by Drs. Dunglison, 
J. K. Mitchell, Pancoast, R. M. Huston, Mutter, Meigs, 
and Bache. This Faculty continued until 1S56, when Pro- 
fessor S. D. Gross succeeded Dr. Miitter. In 1857 Dr. T. 
B. Mitchell took the place of Dr. Huston, and in 1858 Dr. 
Dickson that of Dr. J. K. Mitchell, 

The second medical school founded in this country was at 
New York, under the charter of King's College, in 1767. 
This school has had many vicissitudes, but is now in a 
flourishing condition, and known as the College of Physicians 
and Surgeons of the City of New York, being the Medical 
Department of Columbia College. Its largest graduating 
class was 110 in 1875. 

The Medical Department of Harvard University was 
founded by Dr. John Warren in 1782. Its maximum class 
of graduates was 99 in 1866. Recently it has led the way 
in elevating the standard of medical education, by extending 
its curriculum to three years, establishing a graded course, 
and by having decided to institute a real examination into 
the preliminary education of its students. This has of course 
diminished its classes somewhat, but no one can doubt that 
the decision to aim at quality instead of quantity is a wise 
one, and will in the fulness of time receive its due reward. 

The first medical school in the West was established in 
Lexington, Ky. So early as 1799 a Medical Department 
was added to Transylvania University, Dr. Samuel Brow^n 
being appointed the first professor. Various appointments 



LITERATURE AND INSTITUTIONS. 361 

in the Medical Faculty were made, and a few partial courses 
of lectures were delivered, but the first full course was not 
given until 1817, and the degree of M.D. was first conferred 
in 1818. The founders of the school were Drs. Dudley and 
Caldwell. Its period of greatest prosperity was from 1830 
to 1831, at which last date a disruption took place, and a 
part of the Faculty removed to Louisville. 

The Medical Department of the University of Louisville 
began as the Medical Institute, chartered in 1833. Nothing 
was accomplished, however, until the quarrel in the Tran- 
sylvania School above referred to took place, when Dr. Cald- 
well enlisted in the cause of the Louisville School, and in 
1837 succeeded in obtaining for it a grant of a square of 
ground, and money for buildings and apparatus. Lectures 
began the same year, the Faculty consisting of Drs. Cald- 
well, Cooke, and Yandell, from the Lexington School, and 
of Drs. Cobb, Henry Miller, and J. B. Flint. In 1839 Dr. 
Drake joined the School, and in the following year Dr. S. 
D. Gross took the place of Dr. Flint. In 1846 the School 
was transferred to the University, and in 1874 it had 123 
graduates, its largest class. 

In connection with these schools a special reference is 
due to Dr. Charles Caldwell, their principal promoter. He 
was of Irish descent, born in North Carolina in 1772 ; died 
1853. After obtaining the best education which his native 
State could afford, he went to Philadelphia in 1792, and 
continued the study of medicine under Dr. Rush, passing 
his examination in 1794, and taking his diploma in 1796. 
During the next twenty years his pen was constantly busy 
with lectures, addresses, and controversial articles, many 
of which related to yellow fever. In 1819 he accepted an 
invitation to the Transylvania School, and from this time he 
gave his best energies to this institution, and subsequently 
to the Louisville School. He was one of the most volumi- 
nous writers which this country has produced, but he con- 
31 



3G2 LITERATURE AND INSTITUTIONS. 

tributed little or nothing of permanent or scientific value 
to the literature of his profession, and the only work of his 
which is worth perusal to-day is his autobiography. His 
critical reviews, being dictated almost exclusively by per- 
sonal prejudices, are in almost all cases samples of special 
pleading rather than true criticism, and characterized by 
their "smartness" rather than their justice. 

In the South the Medical College of South Carolina, 
chartered in 1823, leads the way. The Medical College of 
Louisiana was incorporated in 1835, and in 1845 became 
the Medical Department of the University of Louisiana. 
This school is remarkable as having received State aid to 
the amount of $121,000. 

In connection with the medical schools, notice should be 
taken of the Medical Institute of Philadelphia, otherwise 
known as the Summer School, which, in addition to furnish- 
ing instruction to students and supplementing the winter 
course, was of very great value as a training school for 
Professors. It was founded in 181t by Dr. Chapman, and 
with it were connected, from time to time, Drs. Chapman, 
Horner, Dewees, Samuel Jackson, J. K. Mitchell, John 
Bell, Hodge, Neill, Gibson, Gerhard, Norris, and Pepper. 

The total number of graduates from our medical schools 
during the five years ending July 1, 1815, was about 10,250, 
that is, a little over 2000 per year ; the number in 1875 
being about 400 more than in 1871. 

Dr. J. M. Toner estimated the average age of beginning 
practice to be 24^ years, of death 58 years, making an 
average of about 34 years practice to each.^ 

Dr. S. E. Chaille estimates that there are about 47,000 
regular physicians in the United States, being about one to 
every 700 of the population.^ 

1 Statistical Sketch, etc. Indiana Journ. of Med., 1873, vol. iv. 
P 1- 

2 The Medical Colleges, etc. New Orleans Med. and Surg. Journ. > 
1874, vol. i. N. S p. 818. 



LITERATURE AND INSTITUTIONS. 363 

Space is wanting for further details with regard to our 
medical schools. That there are too many of them is a 
general complaint, the answer to which is the same as that 
given above with regard to the like objection with regard 
to medical journals, and which answer is of about the same 
value in each case. 

In attempting to estimate the quantity and value of the 
additions made by the medical profession of this country to 
the world's stock of knowledge of the laws of healthy and 
diseased action, and the means of modifying these actions, 
it is very difficult to make generalizations which shall be at 
once clear, comprehensive, and correct. This difficulty be- 
comes an impossibility, if we are to speak of the education, 
mental characteristics, and professional qualifications of the 
whole body of physicians of this, or any other country, since 
only the most vague and indefinite statements will hold 
good. We have had, and still have, a very few men who 
love science for its own sake, whose chief pleasure is in 
original investigations, and to whom the practice of their 
profession is mainly, or only, of interest as furnishing mate- 
rial for observation and comparison. Such men are to be 
found for the most part only in large cities where libraries, 
hospitals, and laboratories are available for their needs, 
although some of them have preferred the smaller towns 
and villages as fields of labour. The work of our physi- 
cians of this class has been for the most part fragmentary, 
and is found in scattered papers and essays which have been 
pointed out in preceding essays ; but buds and flowers, 
rather than ripened fruit, are what we have to offer. Of the 
highest grade of this class we have thus far produced no 
specimens; the John Hunter, or Virchow, of the United 
States, has not yet given any sign of existence. 

We have in our cities, great and small, a much larger 
class of physicians whose principal object is to obtain 
money, or rather the social position, pleasures, and power, 



364 LITERATURE AND INSTITUTIONS. 

/ 

which money only can bestow. They are clear-headed, 
shrewd, practical men, well educated, because " it pays," 
and for the same reason they take good care to be supplied 
with the best instruments, and the latest literature. Maiiy 
of them take np specialties because the work is easier, and 
the hours of labour are more under their control than in 
general practice. They strive to become connected with 
hospitals and medical schools, not for the love of mental 
exertion, or of science for its own sake, but as a respectable 
means of advertising, and of obtaining consultations. They 
write and lecture to keep their names before the public, and 
they must do both well, or fall behind in the race. They 
have the greater part of the valuable practice, and their 
writings, which constitute the greater part of onr medical 
literature, are respectable in quality, and eminently useful. 

They are the patrons of medical literature, the active 
working members of municipal medical societies, the men 
who are usually accepted as the representatives of the pro- 
fession, not only here, but in all civilized countries ; they 
may be famous physicians and great surgeons in the usual 
sense of the words, and as such, and only as such, should 
they receive the honour which is justly their due. They 
work for the present, and they have their reward in their 
own generation. 

There is another large class, whose defects in general 
culture and in knowledge of the latest improvements in 
medicine, have been much dwelt upon by those disposed to 
take gloomy views of the condition of medical education in 
this country. The preliminary education of these physicians 
was defective, in some cases from lack of desire for it, but 
in the great majority from lack of opportunity, and their 
work in the medical school was confined to so much me- 
morizing of text-books as was necessary to secure a diploma. 
In the course of practice they gradually obtain from personal 
experience, sometimes of a disagreeable kind, a knowledge 



LITERATURE AND INSTITUTIONS. 3G5 

of therapeutics, which enal)les them to treat the majority of 
their cases as successfully, perhaps, as their brethren more 
learned in theory. Occasionally they contribute a paper to 
a journal, or a report to a medical society; but they would 
rather talk than write, and find it very difficult to explain 
how or why they have succeeded, being like many excellent 
cooks in this respect. They are honest, conscientious, hard- 
working men, who are inclined to place great weight on 
their experience, and to be rather contemptuous of what 
they call "book learning and theories." To them our 
medical literature is indebted for a few interesting observa- 
tions, and valuable suggestions in therapeutics, but for the 
most part, their experience, being unrecorded, has but a 
local usefulness. 

These three classes have been referred to simply for the 
purpose of calling attention to the fact that, in speaking of 
"the physicians of the United States," it is necessary to be 
careful. There are many o-ther classes, and they shade into 
each other and into empirfcism in many ways. In discus- 
sions upon this subject, it seems to be often assumed that 
all physicians should possess the same qualifications, and be 
educated to the same standard, which, in one respect, is like 
saying that they should all be six feet high, and in another, 
is like the army regulations, which prescribe the same ration 
and allowance of clothing for Maine and Florida, Alaska 
and Oregon. A young and energetic man who has spent 
six years in obtaining a University education, and four 
more in the study of medicine as it ought to be studied, that 
is to say, in preparing himself to study and investigate for 
the rest of his life, will not settle in certain districts. He 
has invested ten years' labour, and from five to ten thousand 
dollars, and a locality which will give him a maximum income 
of, perhaps, fifteen hundred dollars per annum will not be 
satisfactory, in part because the capital should bring a better 
interest, in part because he will have acquired tastes which 



366 LITERATURE AND INSTITUTIONS. 

will make his life unpleasant in such places. Yet these 
places must have physicians of some sort, and it is not clear 
as to how they are to be supplied, if some of the universal 
and extensive reforms in medical education which have been 
proposed were to be enforced. 

Certainly the standard for admission and for graduation 
at almost all our medical schools is too low, and one-half, 
at least, of these schools have no sufficient reason for exist- 
ence ; but it is not probable that it would improve matters 
much to establish a uniform, which must, of course, be a 
minimum, standard. 

Of the material aids and instruments required for the 
advancement of medical science, such as hospitals, libraries, 
and museums, we have obtained as much as could be ex- 
pected. With the proper use of those we now possess will 
come the demand for, and the supply of, still better facilities 
for the work of the scholar and observer. 

The defects in American medicine are much the same as 
those observed in other branches of science in this country, 
and to a great extent are due to the same causes. 

Culture, to flourish, requires appreciation and sympathy, 
to such an extent, at least, that its utterances shall not seem 
to its audience as if in an unknown tongue. 

We have no reason to boast, or to be ashamed of what 
we have thus far accomplished; it has been but a little while 
since we have been furnished with the means of investigation 
needed to give our observations that accuracy and precision 
which alone can entitle medicine to a place among the 
sciences properly so called ; and we may begin the new 
century in the hope and belief that to us applies the bright 
side of the maxim of Cousin, "It is better to have a future 
than a past." 



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ATTFIELD (JOHN). CHEMISTRY; GENERAL, MEDICAL, AND 
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ANDERSON (McCALL). ON THE TREATMENT OF DISEASES 
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DUNGLISON (EOBLEY). MEDICAL LEXICON; a Dictionary of 
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FULLER (HENRY). ON DISEASES OF THE LUNGS AND AIR 
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ROSS (SAMUEL D.) A PRACTICAL TREATISE ON THE Dis- 
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GIBSON'S INSTITUTES AND PRACTICE OF SURGERY. In two Svo. 
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GOSSELIN (L ) CLINICAL LECTURES ON SURGERY, Delivered 
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CONSPECTUS OF THE MEDICAL SCIENCES. Comprising 

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HODGES (RICHARD M.) PRACTICAL DISSECTIONS. Second edi- 
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TTUGHES. SCRIPTURE GEOGRAPHY AND HISTORY, with 12 
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TTORNER (WILLIAM E.) SPECIAL ANATOMY AND HISTOLOGY. 
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ILL (RERKEIEy). SYPHILIS AND LOCAL CONTAGIOUS DIS- 
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HILLIER (THOMAS). HAND-BOOK OF SKIN DISEASES. Second 
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ALL (MRS. M.) LIVES OF THE QUEENS OF ENGLAND BEFORE 
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TONES (C. HAKDEIELD). CLINICAL OBSERVATIONS ON FUNC- 
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K I EKES (WILLIAM SENHOUSE). A MANUAL OF PHYSIOLOGY. 
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KNAPP (F.) TECHNOLOGY ; OR CHEMISTRY, APPLIED TO THE 
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KENNEDY'S MEMOIRS OF THE LIFE OF WILLIAM WIRT. In 
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LEA (HENRY C.) SUPERSTITION AND FORCE ; ESSAYS ON THE 
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STUDIES IN CHURCH HISTORY. The Rise of the Temporal 

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AN HISTORICAL SKETCH OF SACERDOTAL CELIBACY 



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LAURENCE (J. Z.) A.ND MOON (ROBERT C.) A HANDY-BOOK 
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A MANUAL OF CHEMICAL PHYSIOLOGY. In one very 

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LAWSON (GEORGE). INJURIES OF THE EYE, ORBIT, AND EYE- 
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LUDLOW (J. L.) A MANUAL OF EXAMINATIONS UPON ANA- 
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LAYCOCK (THOMAS). LECTURES ON THE PRINCIPLES AND 
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LYNCH (W. F.) A NARRATIVE OF THE UNITED STATES EX- 
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LYONS (ROBERT D.) A TREATISE ON FEVER. In one neat 8vo. 
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MEIGS (CHAS. D.). ON THE NATURE, SIGNS, AND TREATMENT 
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